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Impact of adherence to CKD-MBD guidelines on mortality among Japanese dialysis patients: an ecological study

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Abstract

Introduction

This study evaluated the association between prefecture-level achievement of chronic kidney disease-mineral and bone disorder (CKD-MBD) parameter targets and mortality in Japanese dialysis patients.

Materials and methods

We conducted an ecological study of all prefectures in Japan using data from the Japanese Society of Dialysis Therapy and National Vital Statistics between 2016 and 2017. We calculated adherence rates to recommend target ranges for CKD-MBD parameters, including phosphate, corrected calcium, and parathyroid hormone (PTH), and explored associations of these rates with prefecture-specific standardized mortality rates (SMRs) among the general population and among prevalent dialysis patients using bivariate association analysis and structural equation modeling.

Results

Prefecture-level adherence to the target phosphate range was significantly and negatively associated with prefecture-specific SMRs in men (standardized estimate (β) = − 0.61, p < 0.001) and women (β = − 0.41, p < 0.001). However, prefecture-level adherence to the target corrected calcium range was significantly and negatively associated with prefecture-specific SMRs only in men (β = − 0.28, p = 0.01). Meanwhile, prefecture-level adherence to the target PTH range was significantly and positively associated with prefecture-specific SMRs in men (β = 0.23, p = 0.04). Prefecture-level SMRs of females in the general population had a significant impact on prefecture-level SMRs of female dialysis patients (β = 0.27, p = 0.03). The models explained 52% of variance in SMR for men and 33% for women.

Conclusion

A higher prefecture-level achievement rate of the target phosphate range recommended by the Japanese CKD-MBD guidelines was associated with a lower prefecture-specific SMR in the Japanese dialysis population.

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Acknowledgements

We thank the committee of the renal data registry of the Japanese Society for Dialysis Therapy (JSDT) for permission to use their registry data. The results in the current study were derived from split data from the WADDA system of the JSDT by the authors. However, the interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as the official policy or interpretation of the JSDT.

Funding

This work was supported by a research grant from JSPS KAKENHI (Grants-in-Aid for Scientific Research, Grant Number JP18K08202) to MW. No funding agency had any role in the study design, collection, analysis and interpretation of data, writing the report, and the decision to submit the report for publication.

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Authors and Affiliations

  1. Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757 Chuo-ku, Niigata, 951-8510, Japan

    Minako Wakasugi

  2. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Ichiei Narita

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  1. Minako Wakasugi
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection and analysis were performed by MW and IN. The first draft of the manuscript was written by MW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Minako Wakasugi.

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Wakasugi, M., Narita, I. Impact of adherence to CKD-MBD guidelines on mortality among Japanese dialysis patients: an ecological study. J Bone Miner Metab 40, 810–818 (2022). https://doi.org/10.1007/s00774-022-01351-5

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  • DOI: https://doi.org/10.1007/s00774-022-01351-5

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