title: [Current status of and regional differences in CKD management and medical cooperation in Japan: from the results of a nationwide questionnaire survey for primary care physicians].
abstract: OBJECTIVE
  The goal of this study was to figure out the current status of and regional differences in CKD management and medical cooperation in Japan.
  
  
  METHODS
  We conducted a nationwide questionnaire survey on CKD management for primary care physicians (PCPs) from December 2012 to March 2013. The questionnaire included 36 items about CKD management and medical cooperation. In order to compare the current status of CKD care and cooperation, we divided the country into 11 areas; Hokkaido, Tohoku, Kanto, Koshin-etsu, Hokuriku, Chubu-Tokai, Kinki, Chugoku, Shikoku, Kyushu and Okinawa.
  
  
  RESULTS
  28,200 sets of questionnaires were delivered to PCPs throughout Japan, and 2,287 (8.1%) doctors responded. Doctors at clinics accounted for 86.5%, and 90.9% were non-nephrologists. Regional differences were evident in the following items regarding CKD management; urinalysis at the first examination, measurement of urinary protein/albumin excretion, frequency of blood testing, counselling with eGFR, prescription of erythropoiesis stimulating agents (ESA). Urinalysis at the first examination was relatively rare in Koshin-etsu and Kanto (p < 0.01), and counseling with eGFR was relatively rare in Tohoku, Shikoku and Koshin-etsu (p = 0.05). Regional differences regarding medical cooperation were evident in the following items; functional level of cooperation, critical path, presence of consulting nephrologist, personal relationship, satisfaction with the nephrologists' reaction to referral, CKD involvement in Specific Medical Checkup/Specific Medical Guidance. Functional level of cooperation was higher in Chugoku, Okinawa, Chubu-Tokai and Hokuriku, and lower in Shikoku, Koshin-etsu and Kinki (p < 0.05). Serum creatinine measurement in the Specific Medical Checkup was involved more frequently in Okinawa, Shikoku, Kanto, Chubu-Tokai, Kyushu and Hokuriku, and less frequently in Tohoku, Chugoku and Kinki (p < 0.01).
  
  
  CONCLUSIONS
  We elucidated the current status of CKD management by PCPs and medical cooperation in Japan. Effective actions to improve CKD care must be proposed on the basis of these data, especially the existing regional differences.
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association,
authors.forename: Takero
authors.initials: T
authors.lastname: Naito
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association,
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Ohtani
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association,
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association,
authors.forename: Masanobu
authors.initials: M
authors.lastname: Miyazaki
authors.affiliation: Renal/Electrolyte Division, Academic Committee, Japan Physicians Association,
authors.forename: Kouji
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Japan Physicians Association, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sugawara
authors.affiliation: Japan Physicians Association, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Japan Physicians Association, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Saruta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult