Department of Inter-Organ Communication Research, 1-757 Asahimachi, Chuo-ku, Niigata, 951-8510, Japan.
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Clin Exp Nephrol. 2023 Feb;27(2):132-140. doi: 10.1007/s10157-022-02284-z. Epub 2022 Oct 8.
Overweight/obesity is a significant risk factor for chronic kidney disease and end-stage kidney disease (ESKD) in the general population. This study evaluated the impact of sex- and prefecture-specific prevalence of overweight/obesity on standardized incidence rates (SIRs) of treated ESKD in Japan.
We conducted an ecological study of all prefectures in Japan (n = 47) using data from the Japanese Society of Dialysis Therapy, national census, the NDB Open Data, and the Statistics of Physicians, Dentists and Pharmacists. We calculated the prevalence of overweight/obesity and proteinuria, standardized mortality ratio, and ratio of nephrology specialists for each prefecture, and explored associations of these variables with sex- and prefecture-specific SIRs of treated ESKD using bivariate association analysis, multiple regression analysis, and structural equation modeling (SEM).
Prefecture-specific SIRs ranged from 0.72 to 1.24 for men and 0.69-1.41 for women. Prefecture-specific SIRs were significantly correlated with both the prevalence of overweight/obesity and prevalence of proteinuria. The prevalence of overweight/obesity showed direct, positive, and significant associations with prefecture-specific SIRs in men (standardized estimate (β) = 0.43, p < 0.001) and women (β = 0.40, p < 0.001). The prevalence of proteinuria showed a significant association with prefecture-specific SIRs only in women (β = 0.33, p = 0.01). The SEM models explained 26% of the variance in SIR for men and 28% for women.
Our findings provide evidence that the prefecture-specific prevalence of overweight/obesity in Japan can explain regional variation in prefecture-specific SIRs of treated ESKD in both sexes.
超重/肥胖是普通人群中慢性肾脏病和终末期肾病（ESKD）的一个重要危险因素。本研究评估了日本性别和县特有超重/肥胖流行率对治疗性 ESKD 标准化发病率（SIR）的影响。
我们使用日本透析治疗学会、全国人口普查、NDB 开放数据和医师、牙医和药剂师统计数据，对日本所有县（n=47）进行了生态研究。我们计算了每个县的超重/肥胖和蛋白尿流行率、标准化死亡率比以及肾病专家比例，并使用双变量关联分析、多元回归分析和结构方程模型（SEM）探索这些变量与性别和县特有治疗性 ESKD SIR 的关联。
男性的县特有 SIR 范围为 0.72 至 1.24，女性为 0.69 至 1.41。县特有 SIR 与超重/肥胖流行率和蛋白尿流行率显著相关。男性（标准化估计（β）=0.43，p<0.001）和女性（β=0.40，p<0.001）的超重/肥胖流行率与县特有 SIR 呈直接、正相关且具有统计学意义。蛋白尿流行率仅与女性县特有 SIR 相关（β=0.33，p=0.01）。SEM 模型解释了男性 SIR 变异的 26%和女性 SIR 变异的 28%。
我们的研究结果提供了证据，表明日本县特有超重/肥胖流行率可以解释两性治疗性 ESKD 县特有 SIR 的区域差异。
