title: Risk factors for CKD progression in Japanese patients: findings from the Chronic Kidney Disease Japan Cohort (CKD-JAC) study.
abstract: BACKGROUND
  Chronic kidney disease (CKD) eventually progresses to end-stage renal disease (ESRD). However, risk factors associated with CKD progression have not been well characterized in Japanese patients with CKD who are less affected with coronary disease than Westerners.
  
  
  METHODS
  A large-scale, multicenter, prospective, cohort study was conducted in patients with CKD and under nephrology care, who met the eligibility criteria [Japanese; age 20-75 years; and estimated glomerular filtration rate (eGFR): 10-59 mL/min/1.73 m2]. The primary endpoint was a composite of time to a 50 % decline in eGFR from baseline or time to the initiation of renal replacement therapy (RRT). The secondary endpoints were the rate of decline in eGFR from baseline, time to a 50 % decline in eGFR from baseline, time to the initiation of RRT, and time to doubling of serum creatinine (Cre) concentration.
  
  
  RESULTS
  2966 patients (female, 38.9 %; age, 60. 3 ± 11.6 years) were enrolled. The incidence of the primary endpoint increased significantly (P < 0.0001) in concert with CKD stage at baseline. The multivariate Cox proportional hazards models revealed that elevated systolic blood pressure (SBP) [hazard ratio (HR) 1.203, 95 % confidence interval (CI) 1.099-1.318)] and increased albumin-to-creatinine ratio (UACR ≥ 1000 mg/g Cre; HR: 4.523; 95 % CI 3.098-6.604) at baseline were significantly associated (P < 0.0001, respectively) with the primary endpoint.
  
  
  CONCLUSIONS
  Elevated SBP and increased UACR were risk factors that were significantly associated with CKD progression to ESRD in Japanese patients under nephrology care. UMIN clinical trial registry number: UMIN000020038.
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. inaguma@nagoya2.jrc.or.jp.
authors.forename: Daijo
authors.initials: D
authors.lastname: Inaguma
authors.affiliation: Nakayamadera Imai Clinic, Takarazuka, Hyogo, Japan.
authors.forename: Enyu
authors.initials: E
authors.lastname: Imai
authors.affiliation: Keio University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Ayano
authors.initials: A
authors.lastname: Takeuchi
authors.affiliation: Chuo University, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohashi
authors.affiliation: Fukushima Medical University, Fukushima, Fukushima, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
authors.affiliation: Showa University, Shinagawa-ku, Tokyo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.affiliation: Nagoya University, Nagoya, Aichi, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Okayama University, Okayama, Okayama, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Makino
authors.affiliation: Yaizu City Hospital, Yaizu, Shizuoka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Hishida
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000208:ethnology / Q000503:physiopathology; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000503:physiopathology; D015994:Incidence; D007564:Japan; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology / Q000628:therapy; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Chronic kidney disease; Estimated glomerular filtration rate; Urine albumin-to-creatinine ratio