Kaneko Tomohiro, Kodani Eitaro, Fujii Hitomi, Nakamura Hiroyuki, Sasabe Hajime, Tamura Yutaka, Tsuruoka Shuichi
Department of Nephrology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan.
Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan.
J Clin Med Res. 2020 Feb;12(2):115-121. doi: 10.14740/jocmr4085. Epub 2020 Feb 1.
Since 2012, Tama City has promoted the early detection of chronic kidney disease (CKD), through an initiative that measures serum creatinine as part of the specific health checkups. We examined preventive measures against CKD deterioration based on the outcomes of this initiative.
The complications, medication status, body mass index, smoking status and other determining factors were surveyed among CKD-diagnosed participants over 3 years between 2013 and 2015. Moreover, factors aggravating CKD were investigated via a survey of medical and dental visits based on health insurance claim data over the same period.
There was an increased rate of comorbid hypertension with each increase in the CKD stage. Comorbidity rates of diabetes mellitus, dyslipidemia, obesity, and smoking increased until CKD stage G4, and then decreased from stage G5. A substantial number of participants with CKD stage G3b and above were not medicated despite comorbidities like hypertension, diabetes mellitus and dyslipidemia. While the rate of regular visits at medical institutions was seen to increase significantly in accordance with the worsening degree of CKD, there were also individuals who, despite having severe CKD, did not visit medical institutions specializing in internal medicine. The rate of dental visits decreased as the CKD stage increased, and further decreased as the diabetic control status worsened.
CKD patients should become aware of the importance of the dental visit because only a limited number of patients with advanced CKD received dental care.
自2012年以来,多摩市通过一项将血清肌酐检测作为特定健康检查一部分的举措,推动慢性肾脏病(CKD)的早期检测。我们根据该举措的结果,研究了针对CKD病情恶化的预防措施。
在2013年至2015年的3年时间里,对被诊断为CKD的参与者的并发症、用药情况、体重指数、吸烟状况及其他决定因素进行了调查。此外,基于同期的健康保险理赔数据,通过对医疗和牙科就诊情况的调查,研究了加重CKD的因素。
随着CKD分期的增加,合并高血压的发生率上升。糖尿病、血脂异常、肥胖和吸烟的合并发生率在CKD G4期之前上升,然后从G5期开始下降。大量CKD G3b及以上分期的参与者尽管合并有高血压、糖尿病和血脂异常等疾病,但未接受药物治疗。虽然随着CKD病情恶化程度的增加,在医疗机构的定期就诊率显著上升,但也有一些人尽管患有严重的CKD,却未前往内科专科医院就诊。随着CKD分期的增加,牙科就诊率下降,并且随着糖尿病控制状况的恶化进一步下降。
CKD患者应意识到牙科就诊的重要性,因为只有少数晚期CKD患者接受了牙科护理。