scholarly journals Lifestyle behaviors associated with the initiation of renal replacement therapy in Japanese patients with chronic kidney disease: a retrospective cohort study using a claims database linked with specific health checkup results

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Azusa Hara ◽  
Takumi Hirata ◽  
Tomonori Okamura ◽  
Shinya Kimura ◽  
Hisashi Urushihara
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Transplantation ◽  
Renal Replacement Therapy ◽  
Retrospective Cohort ◽  
Lifestyle Behaviors ◽  
Health Checkup ◽  
Claims Database ◽  
Skipping Breakfast ◽  
Specific Health

Abstract Background Chronic kidney disease (CKD) is an independent risk factor for progression to an end-stage renal disease requiring dialysis or kidney transplantation. We investigated the association of lifestyle behaviors with the initiation of renal replacement therapy (RRT) among CKD patients using an employment-based health insurance claims database linked with specific health checkup (SHC) data. Methods This retrospective cohort study included 149,620 CKD patients aged 40–74 years who underwent a SHC between April 2008 and March 2016. CKD patients were identified using ICD-10 diagnostic codes and SHC results. We investigated lifestyle behaviors recorded at SHC. Initiation of RRT was defined by medical procedure claims. Lifestyle behaviors related to the initiation of RRT were identified using a Cox proportional hazards regression model with recency-weighted cumulative exposure as a time-dependent covariate. Results During 384,042 patient-years of follow-up by the end of March 2016, 295 dialysis and no kidney transplantation cases were identified. Current smoking (hazard ratio: 1.87, 95% confidence interval, 1.04─3.36), skipping breakfast (4.80, 1.98─11.62), and taking sufficient rest along with sleep (2.09, 1.14─3.85) were associated with the initiation of RRT. Conclusions Among CKD patients, the lifestyle behaviors of smoking, skipping breakfast, and sufficient rest along with sleep were independently associated with the initiation of RRT. Our study strengthens the importance of monitoring lifestyle behaviors to delay the progression of mild CKD to RRT in the Japanese working generation. A substantial portion of subjects had missing data for eGFR and drinking frequency, warranting verification of these results in prospective studies.

scholarly journals A retrospective cohort study of clinical characteristics, treatment patterns, and disease outcomes of chronic kidney disease in patients with diabetes using a Japanese claims database

2020 ◽  
Author(s):  
Toru Yamazaki ◽  
Nariaki Yoshihara ◽  
Jingbo Yi ◽  
Yoko Tanimura ◽  
Crawford Bruce
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Real World ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Index Date ◽  
Treatment Patterns ◽  
Claims Database ◽  
Patients With Diabetes

Abstract Objectives: The primary objective of this study was to characterize the clinical characteristics, treatment patterns, and clinical outcomes of chronic kidney disease (CKD) patients with diabetes, using a Japanese claims database and focusing on the use of mineralocorticoid receptor antagonists (MRAs) in this population in the real-world setting.Methods: This retrospective cohort study used the Medical Data Vision database, a large, electronic health records-based claims database in Japan. The observation period was a maximum of 8 years (from 1st April 2008 to 31st August 2016). The inclusion criteria were a claim with a diagnosis of diabetes (ICD-10: E10-E14), eGFR less than 60 mL/min/1.73 m2 at the index date, and use of any antiglycemic medications within 6 months prior to the index date or during the index month. Patients who had a claim for an MRA drug after the index date were identified as the MRA subcohort. This exploratory study investigated the burden of disease in patients with CKD and diabetes, including demographics, treatments, safety, and time-to-event analysis for renal and cardiovascular-related endpoints.Results: A total of 19,582 patients were included in the analysis, and 2,295 MRA patients were included in the subcohort. Renin-angiotensin-aldosterone system inhibitors were used at baseline by 52.3% in the overall cohort and 58.8% in the MRA subcohort. Cumulative incidences of hyperkalemia were 5.19% in the overall cohort and 7.63% in the MRA subcohort. Cox models showed that the 30–44 mL/min/1.73 m2 eGFR group had a significantly higher hazard of composite cardiovascular outcomes compared to the 45–59 mL/min/1.73 m2 group (HR, 1.22; 95% CI, 1.09–1.36).Conclusion: There are residual risks for hyperkalemia and renal and cardiovascular-related events in diabetic patients with CKD in the real-world setting in Japan, even after starting treatment with steroidal MRA drugs. The unmet needs and burden of disease should be considered in future treatments for CKD patients with diabetes.

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