[Integrated care and expected outcomes over the progression of CKD (chronic kidney disease)]

Among hypertensive cardiovascular complications only end-stage renal failure (ESRD) is progressively increasing, while the increases in the incidence of stroke and coronary heart disease have been suppressed. On the other hand, it is well established that CKD, especially due to diabetic nephropathy and IgA nephropathy, can be arrested into complete remission if treated in the early stages. Therefore, early detection program is highly and urgently required. To achieve this goal, we must consider what we can do now in nation-wide scale including patients, doctors and governments. There are remarkable regional differences in both the incidence of ESRD and the increasing rate within Japan. Japanese Society of Dialysis Therapy has the unique system to register the patients who reach ESRD, resulting in chronic dialysis therapy. Therefore, if we can build the patient identification system compatible to the above, then we immediately know who has reached ESRD. In this way, we can analyze the backgrounds of the ESRD patients to find out the risk factors of CKD in addition to the regional differences. I anticipate that the incidence of ESRD will be reduced in near future in Japan as seen in diabetic nephropathy in Denmark and USA. We must act now to accomplish this important issue: integrated care of CKD.