Risk-Stratified Incidence of Renal Replacement Therapy Initiation: A Longitudinal Analysis Using Medical Claims and Health Checkup Data

Risk-Stratified Incidence of Renal Replacement Therapy Initiation: A Longitudinal Analysis Using Medical Claims and Health Checkup Data

TAKEHIRO SUGIYAMA,^1,2,3 KOJI OBA⁴ and YASUKI KOBAYASHI³

¹Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
²Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
³Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
⁴Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Intervention for higher-risk participants of health checkups especially with diabetes has been started in Japan to prevent renal replacement therapy (RRT) initiation, but evidence about RRT initiation risk among checkup participants has been scarce. To estimate the incidence by risk factors, we conducted a retrospective cohort study using medical claims and checkup data of a community-based insurance scheme in Japan. Beneficiaries who participated in the checkup in 2012-2013 were included and followed up for about five years. We estimated the incidence of RRT initiation by the subject characteristics, followed by investigation for risk factors in bivariate analyses and multivariable regression analyses with Bayesian prior probability distributions. As a result, among 49,252 participants, 37 initiated dialysis (0.21/1,000 person-years); no kidney transplantation was performed during the period. Baseline estimated glomerular filtration rate was strongly associated with dialysis initiation. No dialysis was initiated among those without baseline hypertension; cumulative incidence by hypertension status was significantly different (p < 0.001). Diabetes was significantly associated with dialysis initiation in bivariate analysis, but the association was not significant in multivariable regression analysis [reference: no diabetes; incidence rate ratio (IRR) for diabetes without medication, 3.30 (95% credible interval, 0.48-15.56); IRR for diabetes with medication, 1.69 (95% credible interval, 0.68-3.47)]. In conclusion, potential risk factors for RRT initiation include male sex, comorbid hypertension, and current smoking status, in addition to advanced chronic kidney disease, proteinuria, and diabetes. New initiatives should consider these factors to increase the efficacy of the programs at the population level.

keywords —— claims data; dialysis; health checkup; incidence; Japan

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Tohoku J. Exp. Med., 2019, 248, 125-135

Correspondence: Takehiro Sugiyama, M.D., M.S.H.S., Ph.D., Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.

e-mail: tsugiyama-tky@umin.ac.jp