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American Journal of Kidney Diseases

Risk of CKD Following Detection of Microscopic Hematuria: A Retrospective Cohort Study

  • Yoo Jin Um
    Affiliations
    Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Yoosoo Chang
    Correspondence
    Co-Corresponding authors: Yoosoo Chang, Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250 Taepyung-ro 2ga, Jung-gu, Seoul 04514, South Korea
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
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  • Yejin Kim
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Min-Jung Kwon
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Hyun-Suk Jung
    Affiliations
    Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Kyu-Beck Lee
    Affiliations
    Division of Nephrology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
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  • Kwan Joong Joo
    Affiliations
    Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • In Young Cho
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Sarah H. Wild
    Affiliations
    Usher Institute, University of Edinburgh, Edinburgh, U.K
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  • Christopher D. Byrne
    Affiliations
    Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, U.K

    National Institute for Health and Care Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, U.K
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  • Seungho Ryu
    Correspondence
    Co-Corresponding authors: Seungho Ryu, Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250 Taepyung-ro 2ga, Jung-gu, Seoul 04514, South Korea
    Affiliations
    Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
    Search for articles by this author
Published:November 15, 2022DOI:https://doi.org/10.1053/j.ajkd.2022.09.012

      ABSTRACT

      Rationale & Objective

      Microscopic hematuria is an uncertain risk factor for chronic kidney disease (CKD). We investigated the association between persistent or single episodes of microscopic hematuria and the development of incident CKD overall and separately among men and women.

      Study Design

      Retrospective cohort study.

      Setting and Participants

      A total of 232,220 Korean adults without CKD at baseline who underwent repeated regular health examinations at Kangbuk Samsung Health Study formed the study cohort.

      Exposure

      Microscopic hematuria was defined by ≥5 red blood cells per high-power field. Participants were categorized into one of four groups according to the presence of hematuria at two consecutive examinations: a) no hematuria at both examinations (reference group); b) hematuria followed by no hematuria (regressed hematuria group); c) no hematuria followed by hematuria (developed hematuria group); and d) hematuria at both examinations (persistent hematuria).

      Outcome

      CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 or proteinuria defined as 1+ or more on dipstick examination.

      Analytical Approach

      Semi-parametric proportional hazards models were used to estimate hazard ratios (95%CIs).

      Results

      During a 4.8-year median follow-up, 2,392 participants developed CKD. Multivariable-adjusted hazard ratios (95% CI) for incident CKD, comparing the “regressed,” “developed,” and “persistent” hematuria groups to the “no hematuria” group were 1.85 (1.35–2.53), 3.18 (2.54–3.98), and 5.23 (4.15–6.59), respectively. The association between persistent hematuria and incident CKD was stronger in men than women (Pinteraction < 0.001), although a significant association was observed in both sexes.

      Limitations

      Lack of albuminuria and inability to consider specific glomerular diseases.

      Conclusion

      Men and women with microscopic hematuria, especially persistent hematuria, may be at increased risk of CKD.

      Graphical abstract

      Keywords

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