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Impact of high mortality in incident dialysis patients due to hypertensive nephrosclerosis: a multicenter prospective cohort study in Aichi, Japan

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Abstract

Introduction

An increasing number of patients worldwide require dialysis as a result of hypertensive nephrosclerosis (HTN). However, in Japan, mortality in patients with end-stage renal disease (ESRD) has not been well by primary kidney disease including HTN and diabetic nephropathy (DN). Hence, we examined the differences in mortality among the primary kidney diseases of incident dialysis patients.

Methods

The study was a multicenter prospective cohort analysis including 1520 incident dialysis patients in Aichi prefecture, Japan. We classified patients into three groups according to the primary kidney disease [i.e., a HTN group, n = 384, a DN group n = 658, and a chronic glomerulonephritis (CGN) group, n = 224]. In addition, we classified patients into the HTN group and the DN group using propensity score matching. We compared outcomes including all-cause and infection-related mortality.

Results

The mortality rates of the HTN, the DN, and the CGN group, were 135.9, 64.2, and 34.8 per 1000 patient years, respectively. All-cause mortality and infection-related mortality rates in the HTN group were as high as those in the DN group after adjustment for age, gender, history of cardiovascular disease, and estimated glomerular filtration rate. No significant difference of all-cause mortality was observed after propensity score matching between the two groups (Logrank test: p = 0.523).

Conclusions

The present study was Japan’s first large-scale prospective cohort to demonstrate that HTN is the second most common cause of ESRD. In addition, the prognosis of patients with HTN was as poor as that of patients with DN.

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Acknowledgements

We acknowledge the support provided by the investigators and members of the AICOPP. The Aichi Kidney Foundation funded this study.

Funding

The Aichi Kidney Foundation partially provided funding for this study.

Author information

Authors and Affiliations

  1. Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

    Daijo Inaguma, Eri Ito, Kazuo Takahashi, Hiroki Hayashi, Shigehisa Koide, Midori Hasegawa & Yukio Yuzawa

Authors
  1. Daijo Inaguma
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  2. Eri Ito
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  3. Kazuo Takahashi
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  4. Hiroki Hayashi
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  5. Shigehisa Koide
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  6. Midori Hasegawa
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  7. Yukio Yuzawa
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Consortia

AICOPP Group

Contributions

DI and SK participated in the design of the study and interpretation of data. DI, EI, and SK participated in writing the manuscript. All authors were involved in drafting, reviewing, and approving the final manuscript.

Corresponding author

Correspondence to Daijo Inaguma.

Ethics declarations

Conflict of interest

YY has received research support grants from Otsuka Pharmaceutical Co., Ltd, Kyowa Hakko Kirin Co., Ltd, and Chugai Pharmaceutical Co., Ltd. DI has received lecture fees from Kyowa Hakko Kirin Co., Ltd. and Ono Pharmaceutical Co., Ltd. Other authors have nothing to declare.

Ethics approval

This study was conducted by following Ethical guidelines for Clinical Research by the Japanese Ministry of Health, Labor, and Welfare (created July 30, 2003; full revision December 28, 2004; full revision July 31, 2008) and the Helsinki Declaration (revised 2013) and was approved by the clinical research ethics committees at each AICOPP group facility (the approval number: 20110823-3).

Informed consent

The subjects received oral and written explanations of the purpose of the study and provided their consent in writing. Trial registration is UMIN 7096. Registered 18 January 2012.

Additional information

All authors are members of AICOPP group.

Electronic supplementary material

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Supplementary material 1 (DOCX 24 KB)

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Cite this article

Inaguma, D., Ito, E., Takahashi, K. et al. Impact of high mortality in incident dialysis patients due to hypertensive nephrosclerosis: a multicenter prospective cohort study in Aichi, Japan. Clin Exp Nephrol 22, 1360–1370 (2018). https://doi.org/10.1007/s10157-018-1592-0

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  • DOI: https://doi.org/10.1007/s10157-018-1592-0

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