Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine.
Department of Health Services Research, Faculty of Medicine, University of Tsukuba.
Tohoku J Exp Med. 2019 Jun;248(2):125-135. doi: 10.1620/tjem.248.125.
Intervention for higher-risk participants of health checkups especially with diabetes has been started in Japan to prevent renal replacement therapy (RRT) initiation, but evidence about RRT initiation risk among checkup participants has been scarce. To estimate the incidence by risk factors, we conducted a retrospective cohort study using medical claims and checkup data of a community-based insurance scheme in Japan. Beneficiaries who participated in the checkup in 2012-2013 were included and followed up for about five years. We estimated the incidence of RRT initiation by the subject characteristics, followed by investigation for risk factors in bivariate analyses and multivariable regression analyses with Bayesian prior probability distributions. As a result, among 49,252 participants, 37 initiated dialysis (0.21/1,000 person-years); no kidney transplantation was performed during the period. Baseline estimated glomerular filtration rate was strongly associated with dialysis initiation. No dialysis was initiated among those without baseline hypertension; cumulative incidence by hypertension status was significantly different (p < 0.001). Diabetes was significantly associated with dialysis initiation in bivariate analysis, but the association was not significant in multivariable regression analysis [reference: no diabetes; incidence rate ratio (IRR) for diabetes without medication, 3.30 (95% credible interval, 0.48-15.56); IRR for diabetes with medication, 1.69 (95% credible interval, 0.68-3.47)]. In conclusion, potential risk factors for RRT initiation include male sex, comorbid hypertension, and current smoking status, in addition to advanced chronic kidney disease, proteinuria, and diabetes. New initiatives should consider these factors to increase the efficacy of the programs at the population level.
日本已经开始针对健康检查中风险较高的参与者（尤其是糖尿病患者）进行干预，以预防开始接受肾脏替代疗法（RRT），但有关检查参与者开始接受 RRT 的风险的证据仍然很少。为了按危险因素估计发病率，我们使用日本基于社区的保险计划的医疗报销和检查数据进行了回顾性队列研究。纳入了 2012-2013 年参加检查的参保者，并进行了大约五年的随访。我们根据受试者特征估计了 RRT 开始的发病率，随后进行了单变量分析和贝叶斯先验概率分布的多变量回归分析，以调查危险因素。结果，在 49252 名参与者中，有 37 人开始接受透析（0.21/1000 人年）；在此期间未进行肾脏移植。基线估计肾小球滤过率与透析开始强烈相关。基线无高血压的患者未进行透析；按高血压状态计算的累积发病率差异有统计学意义（p<0.001）。糖尿病在单变量分析中与透析开始显著相关，但在多变量回归分析中无显著相关性[参考：无糖尿病；未服药的糖尿病患者的发病率比（IRR）为 3.30（95%可信区间为 0.48-15.56）；服药的糖尿病患者的 IRR 为 1.69（95%可信区间为 0.68-3.47）]。总之，除了晚期慢性肾脏病、蛋白尿和糖尿病外，RRT 开始的潜在危险因素还包括男性、合并高血压和当前吸烟状态。新的干预措施应考虑这些因素，以提高人群层面计划的效果。
