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Multicenter Study
. 2017 Jun;21(3):446-456.
doi: 10.1007/s10157-016-1309-1. Epub 2016 Jul 13.

Risk factors for CKD progression in Japanese patients: findings from the Chronic Kidney Disease Japan Cohort (CKD-JAC) study

Daijo Inaguma  1 , Enyu Imai  2 , Ayano Takeuchi  3 , Yasuo Ohashi  4 , Tsuyoshi Watanabe  5 , Kosaku Nitta  6 , Tadao Akizawa  7 , Seiichi Matsuo  8 , Hirofumi Makino  9 , Akira Hishida  10 ; Chronic Kidney Disease Japan Cohort Study Group
Affiliations
Multicenter Study

Risk factors for CKD progression in Japanese patients: findings from the Chronic Kidney Disease Japan Cohort (CKD-JAC) study

Daijo Inaguma et al. Clin Exp Nephrol. 2017 Jun.

Abstract

Background: Chronic kidney disease (CKD) eventually progresses to end-stage renal disease (ESRD). However, risk factors associated with CKD progression have not been well characterized in Japanese patients with CKD who are less affected with coronary disease than Westerners.

Methods: A large-scale, multicenter, prospective, cohort study was conducted in patients with CKD and under nephrology care, who met the eligibility criteria [Japanese; age 20-75 years; and estimated glomerular filtration rate (eGFR): 10-59 mL/min/1.73 m2]. The primary endpoint was a composite of time to a 50 % decline in eGFR from baseline or time to the initiation of renal replacement therapy (RRT). The secondary endpoints were the rate of decline in eGFR from baseline, time to a 50 % decline in eGFR from baseline, time to the initiation of RRT, and time to doubling of serum creatinine (Cre) concentration.

Results: 2966 patients (female, 38.9 %; age, 60. 3 ± 11.6 years) were enrolled. The incidence of the primary endpoint increased significantly (P < 0.0001) in concert with CKD stage at baseline. The multivariate Cox proportional hazards models revealed that elevated systolic blood pressure (SBP) [hazard ratio (HR) 1.203, 95 % confidence interval (CI) 1.099-1.318)] and increased albumin-to-creatinine ratio (UACR ≥ 1000 mg/g Cre; HR: 4.523; 95 % CI 3.098-6.604) at baseline were significantly associated (P < 0.0001, respectively) with the primary endpoint.

Conclusions: Elevated SBP and increased UACR were risk factors that were significantly associated with CKD progression to ESRD in Japanese patients under nephrology care. UMIN clinical trial registry number: UMIN000020038.

Keywords: Chronic kidney disease; Estimated glomerular filtration rate; Urine albumin-to-creatinine ratio.

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Conflict of interest statement

Conflict of interest

TW has received a research support Grant from Kyowa Hakko Kirin. KN has consulted for and received a research support Grant from Kyowa Hakko Kirin. TA has consulted for and received lecture free from Kyowa Hakko Kirin. HM has received speaker honoraria and a support Grant from Kyowa Hakko Kirin. Other authors have nothing to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Figures

Fig. 1
Fig. 1
Patient disposition
Fig. 2
Fig. 2
Kaplan–Meier curves for primary endpoint renal event-free Japanese patients with CKD by CKD stage at baseline. CKD chronic kidney disease
Fig. 3
Fig. 3
Panel a Kaplan–Meier curves for primary endpoint renal event-free Japanese patients with CKD in two blood pressure pattern groups formed according to pattern 1. Group 1, ≥140 mmHg in SBP and/or ≥90 mmHg in DBP; Group 2, <140 mmHg in SBP and <90 mmHg in DBP. Panel b Kaplan–Meier curves for primary endpoint renal event-free Japanese patients with CKD in seven blood pressure pattern groups formed according to pattern 2. CKD chronic kidney disease, SBP systolic blood pressure, DBP diastolic blood pressure
Fig. 4
Fig. 4
Kaplan–Meier curves for Japanese patients with CKD who developed renal events according to three categories (<300, 300–999, and ≥1000 mg/g Cre) of UACR. CKD chronic kidney disease, Cre creatinine, UACR urine albumin-to-creatinine ratio
See this image and copyright information in PMC

References

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