Clinical and Experimental Nephrology

, Volume 14, Issue 6, pp 558–570 | Cite as

Chronic Kidney Disease Japan Cohort study: baseline characteristics and factors associated with causative diseases and renal function

  • Enyu ImaiEmail author
  • Seiichi Matsuo
  • Hirofumi Makino
  • Tsuyoshi Watanabe
  • Tadao Akizawa
  • Kosaku Nitta
  • Satoshi Iimuro
  • Yasuo Ohashi
  • Akira Hishida
Original Article



Prevalence of chronic kidney disease (CKD) is estimated to be 13.3 million in Japan, but patient characteristics during the predialysis period (CKD stages 3–5) are not well studied.


We established the Chronic Kidney Disease Japan Cohort (CKD-JAC) to study the incidence of cardiovascular disease (CVD), end-stage renal disease (ESRD), and all-cause mortality in predialysis patients treated by nephrologists for 4 years. The inclusion criteria were (1) Japanese and Asian patients living in Japan, (2) age 20–75 years, and (3) estimated glomerular filtration rate (eGFR) 10–59 ml/min/1.73 m2.


We analyzed 2977 participants for baseline characteristics. Mean eGFR was 28.6 ± 11.8 ml/min/1.73 m2, and mean albuminuria was 976 ± 1340 mg/g Cr. In our study, 91.9% of participants had hypertension, but it was well controlled (131/76 mmHg). Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) were used by most participants. Less than 15% of participants had history of ischemic heart disease, and 11.5% had history of stroke. Heart failure and arteriosclerosis obliterans were present in 3.9% and 3.6% of patients, respectively. Indicators of arteriosclerosis, higher pulse wave velocity (PWV), and high pulse pressure were associated with diabetes and particularly with diabetic nephropathy. Patients included due to glomerulonephritis seemed to be at low risk for atherosclerosis and also to show lower levels of hypertension.


The difference between causative diseases is associated with different comorbidity and level of arteriosclerosis. Future analysis of the cohort will clarify whether incidence of ESRD and CVD differs among causative diseases.


CKD Diabetes Chronic glomerulonephritis Hypertension PWV Pulse pressure 


  1. 1.
    USRDS. International comparison. Am J Kidney Dis. 2010;55(Suppl 1):S343–54.Google Scholar
  2. 2.
    Japanese Society of Dialysis Therapy. An overview of regular dialysis treatment in Japan as of Dec 31, 2008. 2009. Accessed 1 March 2010.
  3. 3.
    Imai E, Horio M, Watanabe T, Iseki K, Yamagata K, Hara S, et al. Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol. 2009;13:621–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Sarnak M, Levey A, Schoolwerth A, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on kidney in cardiovascular disease, high blood pressure research, and epidemiology and prevention. Circulation. 2003;108:2154–69.CrossRefPubMedGoogle Scholar
  5. 5.
    Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.CrossRefPubMedGoogle Scholar
  6. 6.
    Blacher J, Asmar R, Djane S, London GM, Safar ME. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension. 1999;33:1111–7.PubMedGoogle Scholar
  7. 7.
    Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37:1236–41.PubMedGoogle Scholar
  8. 8.
    Shoji T, Emoto M, Shinohara K, Kakiya R, Tsujimoto Y, Kishimoto H, et al. Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease. J Am Soc Nephrol. 2001;12:2117–24.PubMedGoogle Scholar
  9. 9.
    Nakayama M, Metoki H, Terawaki H, Ohkubo T, Kikuya M, Sato T, et al. Kidney dysfunction as a risk factor for first symptomatic stroke events in a general Japanese population—the Ohasama study. Nephrol Dial Transplant. 2007;22:1910–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Lash JP, Go AS, Appel LJ, He J, Ojo A, Rahman M, et al. Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol. 2009;4:1302–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Imai E, Matsuo S, Makino H, Watanabe T, Akizawa T, Nitta K, et al. Chronic Kidney Disease Japan Cohort (CKD-JAC) study: design and methods. Hypertens Res. 2008;3:1101–7.CrossRefGoogle Scholar
  12. 12.
    Miura K, Nakagawa H, Ohashi Y, Harada A, Taguri M, Kushiro T, et al. Four blood pressure indexes and the risk of stroke and myocardial infarction in Japanese men and women: a meta-analysis of 16 cohort studies. Circulation. 2009;119:1892–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.CrossRefPubMedGoogle Scholar
  14. 14.
    McDowell SE, Coleman JJ, Ferner RE. Systemic review and meta-analysis of ethnic differences in risks of adverse reactions to drugs used in cardiovascular medicine. BMJ. 2006;332:1177–81.CrossRefPubMedGoogle Scholar
  15. 15.
    McCullough PA, Li S, Jurkovitz CT, Stevens LA, Wang C, Collins AJ, et al. CKD and cardiovascular disease in screened high-risk volunteer and general populations: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Kidney Dis. 2008;51(4 Suppl 2):S38–45.CrossRefPubMedGoogle Scholar
  16. 16.
    Nakayama M, Sato T, Sato H, Yamaguchi Y, Takeuchi K, Obara K, Kurihara I, Sato K, Hotta O, Seino J, Miyata M, Takeuchi K, Otaka T, Nakayama K, Matsushima M, Otaka T, Kinoshita Y, Taguma Y, Ito S. Different clinical outcomes for cardiovascular events and mortality in chronic kidney disease according to underlying renal disease, Clin Exp Nephrol. 2010. doi: 10.1007/s10157-010-0295-y.
  17. 17.
    Kimoto E, Shoji T, Shinohara K, Hatsuda S, Mori K, Fukumoto S, et al. Regional arterial stiffness in patients with type 2 diabetes and chronic kidney disease. J Am Soc Nephrol. 2006;17:2245–52.CrossRefPubMedGoogle Scholar
  18. 18.
    Wang MC, Tsai WC, Chen JY, Huang JJ. Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease. Am J Kidney Dis. 2005;45:494–501.CrossRefPubMedGoogle Scholar
  19. 19.
    Townsend RR, Wimmer NJ, Chirinos JA, Parsa A, Weir M, Perumal K, et al. Aortic PWV in chronic kidney disease: a CRIC ancillary study. Am J Hypertens. 2010;23:282–9.CrossRefPubMedGoogle Scholar
  20. 20.
    DeLoach SS, Appel LJ, Chen J, Joffe MM, Gadegbeku CA, Mohler ER 3rd, et al. Aortic pulse pressure is associated with carotid IMT in chronic kidney disease: report from Chronic Renal Insufficiency Cohort. Am J Hypertens. 2009;22:1235–41.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2010

Authors and Affiliations

  • Enyu Imai
    • 1
    Email author
  • Seiichi Matsuo
    • 1
  • Hirofumi Makino
    • 2
  • Tsuyoshi Watanabe
    • 3
  • Tadao Akizawa
    • 4
  • Kosaku Nitta
    • 5
  • Satoshi Iimuro
    • 6
  • Yasuo Ohashi
    • 6
  • Akira Hishida
    • 7
  1. 1.Department of NephrologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Medicine and Clinical ScienceOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  3. 3.The Third Department of Internal MedicineFukushima Medical CollegeFukushimaJapan
  4. 4.Department of NephrologyShowa UniversityTokyoJapan
  5. 5.Department of MedicineKidney Center, Tokyo Women’s Medical UniversityTokyoJapan
  6. 6.Department of BiostatisticsSchool of Public Health, The University of TokyoTokyoJapan
  7. 7.First Department of MedicineHamamatsu University School of MedicineHamamatsuJapan

Personalised recommendations