Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Chronic Kidney Disease Japan Cohort (CKD-JAC) Study: Design and Methods

Abstract

The prevalence and incidence of end-stage renal disease (ESRD) in Japan are the highest and the third highest, respectively, in the world, while the incidence of cardiac death in Japan is the lowest among developed countries. A recent study showed that the prevalence of chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2, is extremely high in Japan, about 20% of the adult population. However, the risk of ESRD and cardiovascular disease (CVD) in the CKD population has not been determined nationwide. For this observational study, we will establish a Chronic Kidney Disease Japan Cohort (CKD-JAC) by enrolling 3,000 patients with CKD in 17 clinical centers around Japan, which will be used to determine the incidence of ESRD and CVD in Japanese CKD patients. Risk factors associated with the development of CVD will also be examined. Comorbidity of diabetes in CKD patients will be analyzed to determine whether it is a risk for rapid progression of CKD and high incidence of CVD. In addition, we will study whether the burden of CKD decreases the QOL of patients, and increases hospitalization or health resource utilization. Insights from the CKD-JAC study will provide a basis for future interventional trials focused on reducing the burden of ESRD and CVD in patients with CKD in Japan.

References

  1. Japanese Society of Dialysis Therapy : An Overview of Regular Dialysis Treatment in Japan as of Dec. 31, 2005. CD-ROM ed by Japanese Soc Dialysis Ther 2006.

  2. Perlman R, Finkelstein F, Liu L, et al: Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the renal reserach institute—CKD study. Am J Kidney Dis 2005; 45: 658–666.

    Article  Google Scholar 

  3. Foley R, Parfrey P, Sarnak M : Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32: S112–S119.

    CAS  Article  Google Scholar 

  4. Sarnak M, Levey A, Schoolwerth A, et al: Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on kidney in cardiovascular disease, high blood pressure research, and epidemiology and prevention. Circulation 2003; 108: 2154–2169.

    Article  Google Scholar 

  5. Eknoyan G, Lameire N, Barsoum R : The burdon of kidney disease: improving global outcome. Kidney Int 2004; 66: 1310–1314.

    Article  Google Scholar 

  6. Levey A, Eckardt K, Tsukamoto Y, et al: Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089–2100.

    Article  Google Scholar 

  7. Imai E, Horio M, Iseki K, et al: Prevalence of chronic kidney disease (CKD) in Japanese population predicted by MDRD equation modified by a Japanese coefficient. Clin Exp Nephrol 2007; 11: 156–163.

    Article  Google Scholar 

  8. Feldman H, Appel L, Chertow G, et al: The chronic renal insuficiency cohort (CRIC) study: design and methods. J Am Soc Nephrol 2003; 14: S148–S153.

    Article  Google Scholar 

  9. Matsuo S, Imai E, Horio M, et al: The Japanese equations for estimating glomerular filtration rate (GFR) from serum creatinine. Am J Kidney Dis ( in press).

  10. Nakamura H, Arakawa K, Itakura H, et al: Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA study): a prospective randomized controlled trial. Lancet 2006; 368: 1155–1163.

    CAS  Article  Google Scholar 

  11. Go A, Chertow G, Fan D, MuCulloch C, Hsu C : Chronic kidney disease and risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296–1305.

    CAS  Article  Google Scholar 

  12. Irie F, Iso T, Sairenchi T, et al: The relationships of proteinuria, serum creatinine, glomerular filtration rate with cardiovascular disease mortality in Japanese general population. Kidney Int 2006; 69: 1264–1271.

    CAS  Article  Google Scholar 

  13. Ninomiya T, Kiyohara Y, Kubo M, et al: Chronic kidney disease and cardiovascular disease in a general Japanese population: the Hisayama study. Kidney Int 2006; 68: 228–236.

    Article  Google Scholar 

  14. Culleton B, Larson M, Wilson P, Evans J, Parfrey P, Levy D : Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int 1999; 56: 2214–2219.

    CAS  Article  Google Scholar 

  15. Kubo M, Kiyohara Y, Kato I, et al: Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese community. Stroke 2003; 34: 2349–2354.

    Article  Google Scholar 

  16. Hirobe K, Terai T, Fujioka S, Goto K, Dohi S : Morbidity of myocardial infarction multicenter study in Japan (3M study). Circ J 2005; 69: 767–773.

    Article  Google Scholar 

  17. Shimamoto K, Kita T, Mabuchi H, et al: Effects of hypertension and type 2 diabetes mellitus on the risk of total cardiovascular events in Japanese patients with hypercholesterolemia: implications from the Japan Lipid Intervention Trial (J-LIT). Hypertens Res 2007; 30: 119–123.

    Article  Google Scholar 

  18. Tunstall-Pedoe H, Vanuzzo D, Hobbs M, et al: Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet 2000; 355: 688–700.

    CAS  Article  Google Scholar 

  19. Shepherd J, Cobbe S, Ford I, et al: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–1307.

    CAS  Article  Google Scholar 

  20. Iseki K, Ikeyama Y, Iseki C, Takishita S : Proteinuria and the risk of developing end-stage renal disease. Kidney Int 2003; 63: 1468–1474.

    Article  Google Scholar 

  21. de Zeeuw D, Remuzzi G, Parving H, et al: Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004; 110: 921–927.

    CAS  Article  Google Scholar 

  22. Atkins RC, Briganti EM, Lewis JB, et al: Proteinuria reduction and progression to renal failure in patients with type 2 diabete mellitus and overt nephropathy. Am J Kidney Dis 2005; 45: 281–287.

    Article  Google Scholar 

  23. Culleton B, Larson M, Parfrey P, Kannel W, Levy D : Proteinuria as a risk factor for cardiovascular disease and mortality in older people: a prospective study. Am J Med 2000; 109: 1–8.

    CAS  Article  Google Scholar 

  24. Hillege H, Fidler V, Diercks G, et al: Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002; 106: 1777–1782.

    CAS  Article  Google Scholar 

  25. Xu J, Knowler W, Devereux R, et al: Albuminuria within the “normal” range and risk of cardiovascular disease and death in American Indians: the Strong Heart Study. Am J Kidney Dis 2007; 49: 208–216.

    CAS  Article  Google Scholar 

  26. Rodondi N, Yerly P, Gabriel A, et al: Microalbuminuria, but not cystatin C, is associated with carotid atherosclerosis in middle-aged adults. Nephrol Dial Transplant 2007; 22: 1107–1114.

    CAS  Article  Google Scholar 

  27. Ibsen H, Olsen M, Wachtell K, et al: Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertension study. Hypertension 2005; 45: 198–202.

    CAS  Article  Google Scholar 

  28. Mancia G, Parati G : Ambulatory blood pressure monitoring and organ damage. Hypertension 2000; 36: 894–900.

    CAS  Article  Google Scholar 

  29. Ohkubo T, Imai Y, Tsuji I, et al: Prediction of mortality by ambulatory blood presure monitoring versus screening blood pressure measurement: a pilot study. J Hypertens 1997; 15: 357–364.

    CAS  Article  Google Scholar 

  30. Kario K, Pickering T, Umeda Y, et al: Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives. Circulation 2003; 107: 1401–1406.

    Article  Google Scholar 

  31. Prving H, Lewis J, Ravid M, Remuzzi G, Hunsicker L : Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int 2006; 69: 2057–2063.

    Article  Google Scholar 

  32. Karter A, Ferrara A, Liu J, Moffet H, Ackerson L, Selby J : Ethnic disparities in diabetic complications in an insured population. JAMA 2002; 287: 2519–2527.

    Article  Google Scholar 

  33. Davis D, Shock N : Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretion capacity in adult males. J Clin Invest 1950; 29: 496–507.

    Article  Google Scholar 

  34. Wesson L : Physiology of Human Kidney. New York, Grune & Stratton, 1969, pp 96–108.

    Google Scholar 

  35. Rowe J, Andres R, Tobin J, Norris A, Shock N : The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol 1976; 31: 155–163.

    CAS  Article  Google Scholar 

  36. Eriksen B, Ingebretsen O : The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int 2006; 69: 375–382.

    CAS  Article  Google Scholar 

  37. Lindman R, Tobin J, Shock N : Longitudinal studies on the rate decline in renal function with age. J Am Geriatr Soc 1985; 33: 278–285.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Enyu Imai.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Imai, E., Matsuo, S., Makino, H. et al. Chronic Kidney Disease Japan Cohort (CKD-JAC) Study: Design and Methods. Hypertens Res 31, 1101–1107 (2008). https://doi.org/10.1291/hypres.31.1101

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1291/hypres.31.1101

Keywords

  • cardiovascular disease
  • stroke
  • heart failure
  • proteinuria
  • time to event analysis

Further reading

Search

Quick links