title: Geographic differences in the increasing ESRD rate have disappeared in Japan.
abstract: BACKGROUND
  We previously showed that there are marked geographic differences in the incidence of end-stage renal disease (ESRD) within Japan. In addition, the use of renin-angiotensin system inhibitors was found to be inversely correlated with the increasing ESRD rate. It was recently demonstrated that the incidence of ESRD due to diabetic nephropathy is declining in both Europe and USA. Therefore, we investigated the increasing ESRD rate and its geographic difference in Japan.
  
  
  METHODS
  Each year, the Japanese Society for Dialysis Therapy reports the numbers of patients initiating maintenance dialysis therapy in each prefecture of Japan. We used old (1984-1991) and recent (2001-2008) data to compare the increasing ESRD rate, which was estimated from the slope of the regression line of the annual incidence corrected for population, between the two periods in 11 regions of Japan.
  
  
  RESULTS
  Increasing ESRD rate almost halved, from 11.1 ± 5.6 to 5.4 ± 0.7/million per year from the old to the recent period. Deceleration of the increasing ESRD rate from the old to the recent period was correlated with the incidence in the old period across 11 regions (r = 0.81, p < 0.003); i.e., the deceleration was greater in the regions where ESRD incidence had been higher. Whereas the increasing ESRD rate was significantly different among regions in the old period, this was not the case in the recent period, resulting in uniformity throughout Japan.
  
  
  CONCLUSIONS
  The increasing ESRD rate is slowing in Japan, and its geographic differences, previously observed, have disappeared.
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Wakamatsu-Yamanaka
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan. m-fukuda@med.nagoya-cu.ac.jp.
authors.forename: Michio
authors.initials: M
authors.lastname: Fukuda
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Sato
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Naito
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Togawa
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Tomonari
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Miura
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ichikawa
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Sota
authors.initials: S
authors.lastname: Miyagi
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shirasawa
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Ito
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Genjiro
authors.initials: G
authors.lastname: Kimura
mesh_terms: D044466:Asian People; D003928:Diabetic Nephropathies / Q000150:complications / Q000453:epidemiology; D005843:Geography; D005921:Glomerulonephritis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D007690:Polycystic Kidney Diseases / Q000453:epidemiology; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*