Risk factors for CKD progression in Japanese patients: findings from the Chronic Kidney Disease Japan Cohort (CKD-JAC) study

Clin Exp Nephrol. 2017 Jun;21(3):446-456. doi: 10.1007/s10157-016-1309-1. Epub 2016 Jul 13.


Background: Chronic kidney disease (CKD) eventually progresses to end-stage renal disease (ESRD). However, risk factors associated with CKD progression have not been well characterized in Japanese patients with CKD who are less affected with coronary disease than Westerners.

Methods: A large-scale, multicenter, prospective, cohort study was conducted in patients with CKD and under nephrology care, who met the eligibility criteria [Japanese; age 20-75 years; and estimated glomerular filtration rate (eGFR): 10-59 mL/min/1.73 m2]. The primary endpoint was a composite of time to a 50 % decline in eGFR from baseline or time to the initiation of renal replacement therapy (RRT). The secondary endpoints were the rate of decline in eGFR from baseline, time to a 50 % decline in eGFR from baseline, time to the initiation of RRT, and time to doubling of serum creatinine (Cre) concentration.

Results: 2966 patients (female, 38.9 %; age, 60. 3 ± 11.6 years) were enrolled. The incidence of the primary endpoint increased significantly (P < 0.0001) in concert with CKD stage at baseline. The multivariate Cox proportional hazards models revealed that elevated systolic blood pressure (SBP) [hazard ratio (HR) 1.203, 95 % confidence interval (CI) 1.099-1.318)] and increased albumin-to-creatinine ratio (UACR ≥ 1000 mg/g Cre; HR: 4.523; 95 % CI 3.098-6.604) at baseline were significantly associated (P < 0.0001, respectively) with the primary endpoint.

Conclusions: Elevated SBP and increased UACR were risk factors that were significantly associated with CKD progression to ESRD in Japanese patients under nephrology care. UMIN clinical trial registry number: UMIN000020038.

Keywords: Chronic kidney disease; Estimated glomerular filtration rate; Urine albumin-to-creatinine ratio.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Albuminuria / ethnology
  • Albuminuria / physiopathology
  • Asians*
  • Biomarkers / blood
  • Blood Pressure
  • Creatinine / blood
  • Disease Progression
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Hypertension / ethnology
  • Hypertension / physiopathology
  • Incidence
  • Japan
  • Kaplan-Meier Estimate
  • Kidney / physiopathology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / ethnology*
  • Renal Insufficiency, Chronic / physiopathology
  • Renal Insufficiency, Chronic / therapy
  • Renal Replacement Therapy
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Young Adult


  • Biomarkers
  • Creatinine