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Kidney Week

Abstract: SA-PO1115

Kidney Outcomes Associated with Adherence to Recommendation from Evidence-Based Clinical Practice Guidelines for CKD 2018 in Japanese Real-World Clinical Practice

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Okada, Hirokazu, Saitama Ika Daigaku, Iruma-gun, Saitama, Japan
  • Nyma, Zannatun, Shiga Ika Daigaku, Otsu, Shiga, Japan
  • Yano, Yuichiro, Shiga Ika Daigaku, Otsu, Shiga, Japan
  • Kanegae, Hiroshi, Genki Plaza Medical Center for Healthcare, Tokyo, Japan
  • Kitaoka, Kaori, Shiga Ika Daigaku, Otsu, Shiga, Japan
  • Bayaraa, Nomin, Shiga Ika Daigaku, Otsu, Shiga, Japan
  • Kishi, Seiji, Kawasaki Ika Daigaku, Kurashiki, Okayama, Japan
  • Nagasu, Hajime, Kawasaki Ika Daigaku, Kurashiki, Okayama, Japan
  • Kashihara, Naoki, Kawasaki Ika Daigaku, Kurashiki, Okayama, Japan
Background

Adherence to recommended treatment is critical in chronic kidney disease (CKD) to prevent complications and progression to kidney failure. The purpose of this study was to explore the adherence to recommendation of patients with CKD, using the Japan Chronic Kidney Disease Database (J-CKD-DB-Ex).

Methods

We developed clinical questions (CQ) recommendation scoring from Clinical Practice Guidelines for CKD 2018 (see Table). We quantified adherence to each of the 8 component metrics, with metric scores ranging from 0 points (poor adherence to recommendation) to 8 points (meeting recommendation). Kidney failure defined estimated glomerular filtration rates (eGFR) <15 mL/min/1.73m2 or eGFR ≥30% reduction. We evaluated the adherence of CQ recommendations and the decline of eGFR and composite kidney outcomes by the Cox proportional hazards models adjusted for age, sex, and eGFR baseline.

Results

Among 4,455 CKD patients, mean age was 67.2 years, mean eGFR was 54.6 mL/min per 1.73 m2, and women was 46.5 % at baseline. Scores of CQ recommendation of 0-5 points group was 12.0%, 6 points group was 29.3%, 7 points group was 41.1%, 8 points group was 17.6%. 838 composite kidney outcomes occurred, more than 6 points groups were at significantly lower risk (6 points: HR 0.67, 95% CI 0.54–0.83).

Conclusion

Great adherence of CQ recommendations was associated with prevention of complications and progression to kidney failure.

Clinical questions scoring from Clinical Practice Guidelines for CKD 2018
Variables1 point0 point
(A) Serum Potassium (mmol/L)≤5.4>5.4
(B) Sodium - Chlorine (mmol/L)≥33<33
(C) Administration of RAS inhibitorsYesNo
(D) Serum Calcium (mg/dL)≥8.4<8.4
(E) Serum Phosphorus (mg/dL)≤6.0>6.0
(F) Uric acid (mg/dL)<7.0≥7.0
(G) Low-density lipoprotein cholesterol (mg/dL)<120≥120
(H) Hemoglobin (g/dL)≥11.0<11.0

Funding

  • Other U.S. Government Support