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Clinical and Experimental Nephrology

, Volume 22, Issue 2, pp 309–317 | Cite as

A nationwide prospective cohort study of patients with advanced chronic kidney disease in Japan: The Reach-J CKD cohort study

  • Junichi Hoshino
  • Kei Nagai
  • Hirayasu Kai
  • Chie Saito
  • Yukiko Ito
  • Koichi Asahi
  • Masahide Kondo
  • Kunitoshi Iseki
  • Chiho Iseki
  • Hirokazu Okada
  • Naoki Kashihara
  • Ichiei Narita
  • Takashi Wada
  • Christian Combe
  • Ronald L. Pisoni
  • Bruce M. Robinson
  • Kunihiro YamagataEmail author
Original article

Abstract

Background

Epidemiology and outcomes of Japanese patients with advanced chronic kidney disease (CKD)—an estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m2—has remained largely unexamined.

Methods

We conducted a nationwide survey to determine the distribution of Japanese CKD patients, and are conducting a cohort study of these patients. A questionnaire eliciting details about facilities and their CKD practices was sent to all clinics/hospitals with nephrologists. Based on the survey results, we recruited 2400 advanced CKD patients receiving nephrologist care from at least 30 representative facilities throughout Japan, selected randomly with stratification by region and facility size. Through patient questionnaires and nephrologist-practice surveys aligned with the international CKD Outcomes and Practice Patterns Study (CKDopps), we shall annually or semi-annually collect patient, physician and clinic data prospectively, detailing CKD practices for 5 years, with a primary outcome of death or renal replacement therapy initiation, and secondary outcomes being decline of eGFR by 30% or 50%, CKD progression to CKD G5, or a cardiovascular event.

Results

Of 790 eligible, responding facilities, 330 (41.8%) treat ≥80 advanced CKD patients in the average 3-month period. Regional distribution of these facilities is similar to that of persons in the general population. Hence, the 30 facilities selected for data collection appear to be geographically representative in Japan.

Conclusions

Our study will enhance understanding of various CKD practices and biological data associated with CKD progression, and allow international comparisons using the CKDopps platform. This will provide evidences to improve the health and quality of life for patients with advanced CKD.

Keywords

Prospective cohort study Chronic kidney disease Practice pattern Reach-J CKDopps 

Notes

Acknowledgements

We thank all the nephrology specialists in Japan who responded to our Reach-J survey, Dr. Hiroyuki Hoshimoto, Ms. Yukiko Ito and all the staff members of the Clinical Trial and Research Center, University of Tsukuba (T-CReDO), Mr. Yoshihiro Ishihara and other staff members of Flexible Inc., and Mr. Justin Albert, Mr. Brian Bieber, Mr. Doug Fuller, Ms. Christina Pustulka, and all the staff members of Arbor Research, for their contribution to our work.

The Reach-J CKD collaborators

Dr. Tomoya Hirayama, Kitasaito hospital, Hokkaido; Dr. Nobuhiko Togashi, JR Sapporo hospital, Hokkaido; Dr. Akira Sugiura, Osaki Citizen hospital, Miyagi; Dr. Kunihiro Yamagata, University of Tsukuba, Ibaraki; Dr. Tatsuo Shiigai, Shiigai clinic, Ibaraki; Dr. Kazue Ueki, Toho hospital, Gunma; Dr. Ken Kikkawa, Kikkawa Naika clinic, Saitama; Dr. Tsukasa Nakamura, Shinmatudo Central General Hospital, Chiba; Dr. Hideki Matsukuma, Funabashi Futawa hospital, Chiba; Dr. Shinsuke Harasawa, Nihon University hospital, Tokyo; Dr. Yuko Shibuya, NTT Medical Center Tokyo, Tokyo; Dr. Hitoshi Tagawa, Kichijoji Asahi Hospital; Dr. Shuzo Kobayashi, Shonan-Kamakura General Hospital, Kanagawa; Dr. Masaki Nagasawa, Shinonoi General Hospital, Nagano; Dr. Minako Wakasugi, Niigata University Hospital, Niigata; Dr. Hajime Yamazaki, Nagaoka Red Cross Hospital, Niigata; Dr. Michio Matsumoto, Toyama Saiseikai Toyama Hospital, Toyama; Dr. Shoichi Maruyama, Nagoya University Hospital, Aichi; Dr. Norihiro Suga, Nagoya City West Medical Center, Aichi; Dr. Keiichi Tamagaki, Kyoto Prefectural University of Medicine Hospital, Kyoto; Dr. Taiko Kimura, Nantan Hospital, Kyoto; Dr. Tsutomu Tabata, Inoue Hospital, Osaka; Dr. Shinichi Nishi, Kobe University Hospital, Hyogo; Dr. Yuriko Yonekura, Akashi Medical Center, Hyogo; Dr. Hitoshi Sugiyama, Okayama University Hospital, Okayama; Dr. Naoki Kashihara, Kawasaki Medical School Hospital, Okayama; Dr. Tadashi Sofue, Kagawa University hospital, Kagawa; Dr. Kazuhiko Tsuruya, Kyushu University Hospital, Fukuoka; Dr. Masato Tadokoro, Nagasaki Harbor Medical Center City Hospital, Nagasaki; Dr. Shoichi Fujimoto, University of Miyazaki Hospital, Miyazaki; and Dr. Kiyoyuki Tokuyama, Tokuyama Clinic, Okinawa.

Compliance with ethical standards

Conflict of interest

Dr. Okada is funded by Takeda Pharm., Chugai Pharm., Kyowa-Hakko Kirin, Pfizer, Boehinger Ingelheim, Astellas Pharm., Otsuka Pharm., MSD, Shionogi, Novaltis, Sumitomo Dainippon Pharm., Mitsubishi Tanabe Pharm., and Daiichi Sankyo Co. Dr. Robinson and Dr. Pisoni are members of Clinical Research for the non-profit organization Arbor Research Collaborative for health, which has designed and carried out the Dialysis Outcomes and Practice Pattern Study (DOPPS) Program. The DOPPS program is supported by Amgen, Kyowa Hakko Kirin, AbbVie Inc., Sanofi Renal, Baxter Healthcare, and Vifor Fresenius Medical Care Renal Pharma Ltd. Additional support for specific projects and countries is also provided in Canada by Amgen, BHC Medical, Janssen, Takeda, Kidney Foundation of Canada (for logistics support); in Germany by Hexal, DGfN, Shire, WiNe Institute; and for the Peritoneal-DOPPS in Japan by the Japanese Society for Peritoneal Dialysis (JSPD). The DOPPS.org website lists the full details. JDOPPS was administered by the Arbor Research Collaborative for Health, Ann Arbor, MI, USA, and supported by Kyowa Hakko Kirin Co. Ltd. All support is provided without restrictions on publications. All other authors have no conflict disclosure.

Human and animal rights

The study’s protocol was approved by the Tsukuba institutional review board (IRB) (H27-199) and the review board of the Japanese Society of Nephrology (No. 29), and has been or will be approved by the IRB of each participating facility. The study procedures fully adhered to the Declaration of Helsinki and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, and was registered with the University Hospital Medical Information Network (UMIN000022145).

Informed consent

Informed consent was and will be obtained from all individual participants included in the study.

Funding source

The study was supported by a Grant-in-Aid for Research on Advanced Chronic Kidney Disease, Practical Research Project for Renal Diseases from the Japan Agency for Medical Research and Development, AMED. Preparation of the manuscript was supported in part by JH’s grant from Grants-in-Aid for Scientific Research (JSPS KAKENHI) Grant Number 15K08719, and the Okinaka Memorial Institute.

Supplementary material

10157_2017_1453_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 35 kb)
10157_2017_1453_MOESM2_ESM.docx (27 kb)
Supplementary material 2 (DOCX 27 kb)

References

  1. 1.
    National Kidney F. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.Google Scholar
  2. 2.
    Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int. 2011;80:17–28.CrossRefPubMedGoogle Scholar
  3. 3.
    Group KDIGOKCW. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.CrossRefGoogle Scholar
  4. 4.
    Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375:2073–81.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385:1975–82.CrossRefPubMedGoogle Scholar
  6. 6.
    Li PK, Chow KM, Matsuo S, Yang CW, Jha V, Becker G, et al. Asian chronic kidney disease best practice recommendations: positional statements for early detection of chronic kidney disease from Asian Forum for Chronic Kidney Disease Initiatives (AFCKDI). Nephrology (Carlton). 2011;16:633–41.Google Scholar
  7. 7.
    Mariani L, Stengel B, Combe C, Massy ZA, Reichel H, Fliser D, et al. The chronic kidney disease outcomes and practice patterns study (CKDopps): rationale and methods. Am J Kidney Dis. 2016;68:402–13.CrossRefPubMedGoogle Scholar
  8. 8.
    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
  9. 9.
    Inaguma D, Imai E, Takeuchi A, Ohashi Y, Watanabe T, Nitta K, et al. Risk factors for CKD progression in Japanese patients: findings from the Chronic Kidney Disease Japan Cohort (CKD-JAC) study. Clin Exp Nephrol. 2017;21:446–56.CrossRefPubMedGoogle Scholar
  10. 10.
    Fuller DS, Pisoni RL, Bieber BA, Port FK, Robinson BM. The DOPPS practice monitor for US dialysis care: update on trends in anemia management 2 years into the bundle. Am J Kidney Dis. 2013;62:1213–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, et al. Vascular access use and outcomes: an international perspective from the dialysis outcomes and practice patterns study. Nephrol Dial Transplant. 2008;23:3219–26.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Pisoni RL, Zepel L, Port FK, Robinson BM. Trends in US vascular access use, patient preferences, and related practices: an update from the US DOPPS practice monitor with international comparisons. Am J Kidney Dis. 2015;65:905–15.CrossRefPubMedGoogle Scholar
  13. 13.
    Hasegawa T, Bragg-Gresham JL, Pisoni RL, Robinson BM, Fukuhara S, Akiba T, et al. Changes in anemia management and hemoglobin levels following revision of a bundling policy to incorporate recombinant human erythropoietin. Kidney Int. 2011;79:340–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Astor BC, Matsushita K, Gansevoort RT, van der Velde M, Woodward M, Levey AS, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int. 2011;79:1331–40.CrossRefPubMedGoogle Scholar
  15. 15.
    Gansevoort RT, Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, et al. Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes. A collaborative meta-analysis of general and high-risk population cohorts. Kidney Int. 2011;80:93–104.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey A, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int. 2011;79:1341–52.CrossRefPubMedGoogle Scholar
  17. 17.
    Coresh J, Turin TC, Matsushita K, Sang Y, Ballew SH, Appel LJ, et al. Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality. JAMA. 2014;311:2518–31.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Anderson AH, Yang W, Townsend RR, Pan Q, Chertow GM, Kusek JW, et al. Time-updated systolic blood pressure and the progression of chronic kidney disease: a cohort study. Ann Intern Med. 2015;162:258–65.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Isakova T, Xie H, Yang W, Xie D, Anderson AH, Scialla J, et al. Fibroblast growth factor 23 and risks of mortality and end-stage renal disease in patients with chronic kidney disease. JAMA. 2011;305:2432–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    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;31:1101–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Ninomiya T, Kiyohara Y, Kubo M, Tanizaki Y, Doi Y, Okubo K, et al. Chronic kidney disease and cardiovascular disease in a general Japanese population the Hisayama study. Kidney Int. 2005;68:228–36.CrossRefPubMedGoogle Scholar
  22. 22.
    Nakayama M, Sato T, Sato H, Yamaguchi Y, Obara K, Kurihara I, et al. Different clinical outcomes for cardiovascular events and mortality in chronic kidney disease according to underlying renal disease: the Gonryo study. Clin Exp Nephrol. 2010;14:333–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Iseki K, Iseki C, Ikemiya Y, Fukiyama K. Risk of developing end-stage renal disease in a cohort of mass screening. Kidney Int. 1996;49:800–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Iseki K, Asahi K, Moriyama T, Yamagata K, Tsuruya K, Yoshida H, et al. Risk factor profiles based on estimated glomerular filtration rate and dipstick proteinuria among participants of the specific health check and guidance system in Japan 2008. Clin Exp Nephrol. 2012;16:244–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Konta T, Hao Z, Abiko H, Ishikawa M, Takahashi T, Ikeda A, et al. Prevalence and risk factor analysis of microalbuminuria in Japanese general population: the Takahata study. Kidney Int. 2006;70:751–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Irie F, Iso H, Sairenchi T, Fukasawa N, Yamagishi K, Ikehara S, et al. The relationships of proteinuria, serum creatinine, glomerular filtration rate with cardiovascular disease mortality in Japanese general population. Kidney Int. 2006;69:1264–71.CrossRefPubMedGoogle Scholar
  27. 27.
    Rosansky SJ, Clark WF. Has the yearly increase in the renal replacement therapy population ended? J Am Soc Nephrol. 2013;24:1367–70.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Crews DC, Scialla JJ, Liu J, Guo H, Bandeen-Roche K, Ephraim PL, et al. Predialysis health, dialysis timing, and outcomes among older United States adults. J Am Soc Nephrol. 2014;25:370–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Rosansky SJ, Eggers P, Jackson K, Glassock R, Clark WF. Early start of hemodialysis may be harmful. Arch Intern Med. 2011;171:396–403.PubMedGoogle Scholar
  30. 30.
    Yamagata K, Nakai S, Iseki K, Tsubakihara Y. Late dialysis start did not affect long-term outcome in Japanese dialysis patients: long-term prognosis from Japanese Society for [corrected] Dialysis Therapy Registry. Ther Apher Dial. 2012;16:111–20.CrossRefPubMedGoogle Scholar
  31. 31.
    Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development of the kidney disease quality of life (KDQOL) instrument. Qual Life Res. 1994;3:329–38.CrossRefPubMedGoogle Scholar
  32. 32.
    Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10:77–84.PubMedGoogle Scholar
  33. 33.
    Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10:20–30.CrossRefPubMedGoogle Scholar
  34. 34.
    Topolski TD, LoGerfo J, Patrick DL, Williams B, Walwick J, Patrick MB. The rapid assessment of physical activity (RAPA) among older adults. Prev Chronic Dis. 2006;3:A118.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Weidmer BA, Cleary PD, Keller S, Evensen C, Hurtado MP, Kosiak B, et al. Development and evaluation of the CAHPS (consumer assessment of healthcare providers and systems) survey for in-center hemodialysis patients. Am J Kidney Dis. 2014;64:753–60.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Junichi Hoshino
    • 1
  • Kei Nagai
    • 2
  • Hirayasu Kai
    • 2
  • Chie Saito
    • 2
  • Yukiko Ito
    • 3
  • Koichi Asahi
    • 4
  • Masahide Kondo
    • 5
  • Kunitoshi Iseki
    • 6
  • Chiho Iseki
    • 6
  • Hirokazu Okada
    • 7
  • Naoki Kashihara
    • 8
  • Ichiei Narita
    • 9
  • Takashi Wada
    • 10
  • Christian Combe
    • 11
  • Ronald L. Pisoni
    • 12
  • Bruce M. Robinson
    • 12
  • Kunihiro Yamagata
    • 2
    Email author
  1. 1.Nephrology Center, Toranomon HospitalTokyoJapan
  2. 2.Department of Nephrology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  3. 3.The Clinical Trial and Research CenterUniversity of TsukubaTsukubaJapan
  4. 4.Department of Nephrology and HypertensionFukushima Medical UniversityFukushimaJapan
  5. 5.Department of Health Care Policy and Health Economics, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  6. 6.Clinical Research Support CenterTomishiro Central HospitalOkinawaJapan
  7. 7.Department of NephrologySaitama Medical UniversitySaitamaJapan
  8. 8.Department of Nephrology and HypertensionKawasaki Medical SchoolOkayamaJapan
  9. 9.Division of Clinical Nephrology and RheumatologyNiigata University Graduate School of Medical and Dental ScienceNiigataJapan
  10. 10.Division of Nephrology, Department of Nephrology and Laboratory MedicineKanazawa UniversityKanazawaJapan
  11. 11.Service de Néphrologie Transplantation Dialyse Hôpital Pellegrin Centre Hospitalier Universitaire de BordeauxBordeauxFrance
  12. 12.Arbor Research Collaborative for HealthAnn ArborUSA

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