Kimura Tomomi, Snijder Robert, Nozaki Kazutoshi
Advanced Informatics and Analytics, Astellas Pharma Inc., Tokyo, Japan.
Advanced Informatics and Analytics, Astellas Pharma Europe Ltd., Leiden, The Netherlands.
Kidney Int Rep. 2020 Apr 10;5(5):694-705. doi: 10.1016/j.ekir.2020.03.006. eCollection 2020 May.
Although early intervention for chronic kidney disease (CKD) and renal anemia are desirable, these conditions are often asymptomatic during their early stages and may be underdiagnosed.
We retrospectively analyzed Japanese administrative claims data for general and hospital populations. The data period for the general and hospital data ranged from January 2011 to December 2016 and from April 2008 to July 2017, respectively. CKD stage was determined by estimated glomerular filtration rate (eGFR). Anemia was defined per Japanese guidelines using hemoglobin (Hb) values. The proportion of patients who had eGFR-defined stages G3-G5 CKD without a CKD diagnosis, and Hb-defined anemia without an anemia diagnosis or treatment records, was estimated.
Among 16,779 (general) and 68,161 (hospital) patients, a high proportion of G3 CKD patients did not have a CKD-related diagnosis (general: G3a, 95.0%; G3b, 68.4%; hospital: G3a, 89.2%; G3b, 67.9%); however, some patients were treated with antihypertensives. Among anemic patients, 75.7% (G3a) and 66.7% (G3b) of the general population, and 56.2% (G3a) and 47.5% (G3b) of the hospital population, did not have an anemia-related diagnosis or treatment. CKD and anemia were more likely to be diagnosed in patients with G4 and G5 CKD.
A high proportion of G3 CKD patients did not have a CKD-related diagnosis. Likewise, many anemic patients with G3 CKD did not have an anemia-related diagnosis. Despite the lack of a CKD-related diagnosis, some patients received appropriate treatment (e.g., antihypertensives). Further outreach to CKD and anemia patients at earlier stages may be warranted.
尽管对慢性肾脏病（CKD）和肾性贫血进行早期干预是理想的，但这些疾病在早期阶段通常无症状，可能未被充分诊断。
我们回顾性分析了日本针对普通人群和住院人群的行政索赔数据。普通人群和住院人群的数据时间段分别为2011年1月至2016年12月以及2008年4月至2017年7月。CKD分期由估计肾小球滤过率（eGFR）确定。贫血根据日本指南使用血红蛋白（Hb）值进行定义。估算了eGFR定义为G3 - G5期CKD但无CKD诊断的患者比例，以及Hb定义为贫血但无贫血诊断或治疗记录的患者比例。
在16779名（普通人群）和68161名（住院人群）患者中，很大一部分G3期CKD患者没有CKD相关诊断（普通人群：G3a，95.0%；G3b，68.4%；住院人群：G3a，89.2%；G3b，67.9%）；然而，一些患者接受了抗高血压治疗。在贫血患者中，普通人群中75.7%（G3a）和66.7%（G3b）以及住院人群中56.2%（G3a）和47.5%（G3b）没有贫血相关诊断或治疗。G4和G5期CKD患者的CKD和贫血更有可能被诊断出来。
很大一部分G3期CKD患者没有CKD相关诊断。同样，许多G3期CKD贫血患者没有贫血相关诊断。尽管缺乏CKD相关诊断，但一些患者接受了适当治疗（如抗高血压治疗）。可能有必要对早期的CKD和贫血患者进行进一步的宣传推广。
