We examined the effect of an angiotensin receptor blocker on survival [25]. In a multicenter prospective, randomized, open-label, blinded-endpoint trial, we assigned 469 patients on chronic hemodialysis (HD) with hypertension to receive the angiotensin receptor blocker olmesartan (n = 235) or a treatment other than an angiotensin receptor blocker or angiotensin-converting enzyme inhibitor (n = 234). Lowering blood pressure with an angiotensin receptor blocker did not significantly lower the risk of major cardiovascular events or death

among patients with hypertension on chronic HD [26]. Two community-based registries for ESKD patients and general screening have been available to us [27, 28]. The Okinawa General Health Maintenance Association (OGHMA) has been performing check details universal screening PLX3397 annually in Okinawa. Since 1983, they have filed records in the computer registry. With full collaboration of the physicians and medical staff, we were able to match subjects who participated in the screening and later developed ESKD.

Because the area consists of sub-tropical islands, the ESKD or CKD stage 5 patients reside exclusively in Okinawa. After verifying the databases from 1983 (n = 106,182) and 1993 (n = 143,948), we analyzed the relationship between commonly measured laboratory variables and ESKD [27–40]. The total number of identified ESKD patients was 420 from 1983 to 2000. Among the variables examined, dipstick proteinuria had the strongest association; the greater the dipstick proteinuria, the higher the risk of developing ESKD (Fig. 2) [28]. Although the dipstick test is ‘semi-quantitative’, the test is clearly ‘dose-dependent’. Serum creatinine was tested in 14 % of patients in 1983 and 35 % in 1993. In addition to dipstick proteinuria, CHIR-99021 nmr hematuria, blood pressure, body mass index (BMI), serum creatinine, uric acid, and anemia were significant predictors of developing ESKD. Other factors, such as smoking, plasma glucose, dyslipidemia, and metabolic syndrome, also played

a role in the development of CKD and ESKD, suggesting the necessity of a multidisciplinary approach. The risk factors related to the development of ESKD are summarized in Table 2 [41]. Fig. 2 Risk of developing ESKD based on dipstick proteinuria (cited from ref. [28]) Table 2 Risk factors for the development of ESKD (modified from Iseki et al. CEN2005 [41]) Patient demographics  Age  Sex  Race  Past history of cardiovascular disease  Family history of cardiovascular disease Clinical and laboratory variables  Proteinuria  Hematuria  Hypertension  Diabetes (hyperglycemia)  Hyperuricemia  Anemia  Low eGFR Lifestyle  Smoking  Obesity, metabolic syndrome  Sleep disturbance Only a few studies outside Japan have examined the effect of microhematuria on developing ESKD. Microhematuria is relatively common, particular in elderly women.