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Clinical features of CKD-MBD in Japan: cohort studies and registry

Takayuki Hamano1, Yusuke Sakaguchi2, Naohiko Fujii3

  • 1Department of Comprehensive Kidney Disease Research (CKDR), Osaka University Graduate School of Medicine, D11, 2-2 Yamadaoka, Suita, Osaka, Japan. hamatea@kid.med.osaka-u.ac.jp.

Clinical and Experimental Nephrology
|December 13, 2016
PubMed

Insights

Japanese CKD-MBD guidelines uniquely target lower intact parathyroid hormone levels, informed by nationwide registry data. Observational studies highlight vitamin D and FGF23 as predictors of renal outcomes and LVH in predialysis patients.

Area of Science:

  • Nephrology
  • Endocrinology
  • Public Health

Background:

  • Randomized controlled trials (RCTs) are crucial, but observational studies and registries offer vital insights into risk factors for Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD).
  • Japanese CKD-MBD guidelines feature lower target intact parathyroid hormone (iPTH) levels compared to international standards, based on the Japan Renal Data Registry.
  • Low vitamin D status and elevated fibroblast growth factor 23 (FGF23) are identified risk factors for adverse renal outcomes in predialysis patients in Japan.

Purpose of the Study:

  • To analyze the unique aspects of Japanese CKD-MBD guidelines and the role of observational studies in informing evidence-based medicine.
  • To explore risk factors for renal outcomes and potential new components of CKD-MBD, such as left ventricular hypertrophy (LVH).
  • To evaluate the efficacy and safety of CKD-MBD medications in Japanese patients, considering potential differences from other populations.

Main Methods:

  • Analysis of nationwide data from the Japan Renal Data Registry.
  • Utilizing cohort studies to identify risk factors for renal outcomes and associations with FGF23 and LVH.
  • Employing sophisticated analysis methods for observational studies, including facility-level analysis and marginal structural models, to minimize bias.

Main Results:

  • Japanese CKD-MBD guidelines incorporate lower iPTH targets informed by national data.
  • Low vitamin D and high FGF23 levels predict poor renal outcomes; FGF23 is also associated with LVH and heart failure.
  • Observational studies indicate differences in medication side effects, compliance, and effective doses for CKD-MBD in Japanese patients, with cinacalcet showing mortality benefits at low doses.

Conclusions:

  • Observational studies are indispensable for understanding CKD-MBD, especially when RCTs are not feasible.
  • Findings support considering LVH as a fourth component of CKD-MBD.
  • Data from Japanese studies are crucial for developing tailored CKD-MBD guidelines and treatment strategies for the Japanese population.

Keywords:
25-Hydroxyvitamin DActive vitamin DCinacalcetFibroblast growth factor 23Lanthanum carbonateMagnesiumSevelamer

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