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Multicenter Study
. 2025 Jun;38(5):1385-1394.
doi: 10.1007/s40620-025-02299-1. Epub 2025 May 8.

Association between primary care physician-nephrologist collaboration and clinical outcomes in patients with stage 5 chronic kidney disease: a JOINT-KD cohort study

Minoru Murakami  1   2   3 , Takuya Aoki  4   5 , Yoshifumi Sugiyama  4   6 , Sho Sasaki  7   8 , Hiroki Nishiwaki  9 , Masahiko Yazawa  10 , Yoshihiko Raita  11 , Hiroo Kawarazaki  12   13 , Hideaki Shimizu  14 , Yoshihiro Nakamura  15   16 , Yosuke Saka  17 , Masato Matsushima  4
Affiliations
Multicenter Study

Association between primary care physician-nephrologist collaboration and clinical outcomes in patients with stage 5 chronic kidney disease: a JOINT-KD cohort study

Minoru Murakami et al. J Nephrol. 2025 Jun.

Abstract

Background: Primary care physician-nephrologist collaboration plays an important role in the management of chronic kidney disease (CKD). However, the benefits of such collaboration in patients with stage 5 CKD remain unclear.

Methods: We conducted a retrospective cohort study of adult outpatients with stage 5 CKD across nine nephrology centers in Japan. The exposure of interest was primary care physician-nephrologist collaboration. We examined the association between primary care physician-nephrologist collaboration and clinical outcomes in adult outpatients with stage 5 CKD: dialysis initiation and cause-specific hospitalizations using the Fine-Gray models, which treat death and preemptive kidney transplantation and death and kidney replacement therapy as competing risk events, respectively.

Results: Of the 570 patients included in the analysis, 91 (16.0%) received primary care physician-nephrologist collaboration, whereas the remaining patients were treated by nephrologists alone. During a median follow-up of 1.4 years, 399 (70.0%) patients started dialysis, 11 (1.9%) received preemptive kidney transplantation, and 53 (9.3%) died. There were no significant between-group differences in dialysis initiation and CKD- and cardiovascular-related hospitalizations (adjusted subdistribution hazard ratio [SHR] [95% confidence interval], 0.89 [0.64-1.23], 1.22 [0.78-1.90], and 0.95 [0.46-1.98], respectively). However, primary care physician-nephrologist collaboration was associated with a lower risk of infection-related hospitalization (adjusted SHR [95% confidence interval], 0.36 [0.15-0.87]).

Conclusions: Our findings suggest that primary care physician-nephrologist collaboration in the management of stage 5 CKD is not associated with delayed dialysis initiation but is associated with a lower risk of infection-related hospitalization, indicating the potential benefits of primary care physician-nephrologist collaboration in stage 5 CKD.

Keywords: Chronic kidney disease; Collaboration; Nephrologist; Primary care physician.

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Conflict of interest statement

Declarations. Conflict of interest: M. Matsushima received speaker’s honoraria from The Japanese Society of Clinical Nutrition and The Japanese Clinical Nutrition Association. M. Matsushima’s son-in-law worked at IQVIA Services Japan K.K., which is a contract research organization and a contract sales organization. M. Matsushima’s son-in-law works at Syneos Health Clinical K.K., which is a contract research organization and a contract sales organization. No other authors have any financial or proprietary interests in any material discussed in this article. Ethical approval: The JOINT-KD study was performed in line with the Declaration of Helsinki. Approval was granted by the institutional review board of each participating facility (approval number of Saku Central Hospital R201709-06). Statement of human and animal rights: The present study complied with the ethical guidelines for human studies and did not involve animal experiments. Informed consent to participate: Owing to the retrospective nature of this study, the requirement for written informed consent was waived, and the opt-out method was used.

Figures

Fig. 1
Fig. 1
Variation in the proportion of patients who received primary care physician-nephrologist collaboration by facility. The proportion was calculated by dividing the number of patients who received primary care physician-nephrologist collaboration by the total number of patients with stage 5 CKD at that hospital. CKD chronic kidney disease
Fig. 2
Fig. 2
Cumulative incidence function curves for dialysis initiation and cause-specific hospitalization between the collaboration and non-collaboration groups. Death and preemptive kidney transplantation were treated as competing risk events for dialysis initiation, whereas death and kidney replacement therapy were treated as competing risk events for cause-specific hospitalization. a Dialysis initiation. b CKD-related hospitalization. c Cardiovascular hospitalization. d Infection-related hospitalization. CKD chronic kidney disease
See this image and copyright information in PMC

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