The important role of primary care physicians in chronic kidney disease follow-up

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  • Okamoto Yasuko
    Japan Health Insurance Association, Tokyo Branch
  • Ogawa Tomoko
    Japan Health Insurance Association, Tokyo Branch
  • Baba Takehiko
    Japan Health Insurance Association, Tokyo Branch
  • Tajima Tetsuya
    Japan Health Insurance Association, Tokyo Branch
  • Yanai Kunio
    Japan Health Insurance Association, Tokyo Branch
  • Kakuta Toru
    Tokyo Medical Association
  • Kondo Taro
    Tokyo Medical Association
  • Takahashi Toshimasa
    Japan Health Insurance Association, Tokyo Branch Bosei Shinjuku Minamiguchi Clinic Division of Nephrology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo Hospital

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Other Title
  • 健診受診者の慢性腎臓病（CKD）対策における「かかりつけ医」の重要性
  • ～全国健康保険協会東京支部CKD受診勧奨と受診動向アンケート調査から～

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Objective. We investigated visit trends of participants with suspected Chronic Kidney Disease (CKD) who received secondary consultation after health checkups to identify effective countermeasures.<br> Design. We administered a questionnaire survey to Tokyo residents at medical institutions, in cooperation with the Tokyo Medical Association.<br> Participants and Setting. Participants were selected from a population of 586,766 individuals (mean age, 50.6 years; 63.6% male) attending a preventive health checkups for lifestyle-related diseases conducted by the Japan Health Insurance Association, Tokyo Branch in both 2012 and 2013.<br> Methods. CKD severity classification comprised urine protein results examined using a test paper method and eGFR level. We selected participants with red or orange CKD heat maps both years, and those with yellow heat maps if the eGFR level was reduced by 1.0 mL/min/1.73m2 or more from the previous year. Additionally, the data on hypertension, diabetes mellitus, dislipidemia and obesity were extracted for untreated participants from their receipt information. To investigate the visit trends among Tokyo residents, we administered a questionnaire survey at the medical institutions, in cooperation with the Tokyo Medical Association. We created the eGFR graphs indicating their renal function.<br> Results. Of the 5,210 untreated people (0.83%), 2,468 Tokyo residents received the survey; 345 (14.0%) returned the questionnaire. Analysis revealed 62.0% (214) “first visits”; 31.9% (110) visited a nephrologist. Of the 68.1% (235) who visited a primary care physician, 66.0% (155/235) “continued treatment or follow-up in the same hospital” and 8.9% (21) were “introduced to a nephrologist”. The questionnaire return rate of the group with the eGFR graph was significantly higher.<br> Conclusion. Primary care physicians play a major role in CKD countermeasures after a health check-up and they should be active in CKD treatment in cooperation with nephrologists.

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