Abstract
BackgroundChronic kidney disease (CKD) is an independent risk factor for progression to an end-stage renal disease requiring dialysis or kidney transplantation. We investigated the association of lifestyle behaviors with the initiation of renal replacement therapy (RRT) among CKD patients using an employment-based health insurance claims database linked with specific health checkup (SHC) data.MethodsThis retrospective cohort study included 149,620 CKD patients aged 40–74 years who underwent a SHC between April 2008 and March 2016. CKD patients were identified using ICD-10 diagnostic codes and SHC results. We investigated lifestyle behaviors recorded at SHC. Initiation of RRT was defined by medical procedure claims. Lifestyle behaviors related to the initiation of RRT were identified using a Cox proportional hazards regression model with recency-weighted cumulative exposure as a time-dependent covariate.ResultsDuring 384,042 patient-years of follow-up by the end of March 2016, 295 dialysis and no kidney transplantation cases were identified. Current smoking (hazard ratio: 1.87, 95% confidence interval, 1.04─3.36), skipping breakfast (4.80, 1.98─11.62), and taking sufficient rest along with sleep (2.09, 1.14─3.85) were associated with the initiation of RRT.ConclusionsAmong CKD patients, the lifestyle behaviors of smoking, skipping breakfast, and sufficient rest along with sleep were independently associated with the initiation of RRT. Our study strengthens the importance of monitoring lifestyle behaviors to delay the progression of mild CKD to RRT in the Japanese working generation. A substantial portion of subjects had missing data for eGFR and drinking frequency, warranting verification of these results in prospective studies.
Highlights
Chronic kidney disease (CKD) is an independent risk factor for progression to an end-stage renal disease requiring dialysis or kidney transplantation
Using an employment-based large-scale claims database linked with specific health checkup (SHC) data, we investigated the association of cumulative exposure to lifestyle behaviors with the initiation of chronic renal replacement therapy (RRT) among CKD patients identified using both claims records and SHC results
CKD patients were identified by either or both of the following criteria: (1) a disease code for CKD according to the International Classification of Diseases, Tenth Revision (ICD-10), [15] as shown in eTable 1, recorded in the claims database; and (2) an estimated glomerular filtration rate less than 60 ml/min per 1.73 m2 or positive proteinuria according to the SHC results [3]
Summary
Chronic kidney disease (CKD) is an independent risk factor for progression to an end-stage renal disease requiring dialysis or kidney transplantation. CKD is an independent risk factor for progression to end-stage renal disease requiring dialysis or kidney transplantation [3, 4]. In 2017, approximately 335,000 patients were receiving maintenance dialysis, [5] the medical cost of which reached 1600 billion yen and accounted for 4% of the total health care budget in Japan that year [6]. Due to difficulties in ensuring sufficient statistical power to detect and analyze low-incidence RRT events, few studies have investigated factors which predict the initiation of chronic renal replacement therapy (RRT) among CKD patients, including lifestyle factors [9]
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