[Factors associated with dialysis initiation in Ehime, Japan]

Objective　This study aimed to clarify the rate of dialysis initiation among the National Health Insurance (NHI) members and identify factors associated with individuals who underwent specific health checkups. These findings were shared with NHI insurers to help develop effective health services and reduce the incidence of chronic kidney disease (CKD).Method　We analyzed individuals aged 40-74 years who were insured under the NHI in Ehime Prefecture in 2012, excluding those already on dialysis. Individual patient data were sourced from the National Health Insurance Database and Specified Health Examination Data Management System. The dependent variable was dialysis initiation, whereas the independent variables included various associated factors. A 4-year cumulative rate of dialysis initiation was calculated from 2013 to 2016 and stratified by age and participation in specific health checkups. Poisson regression analysis was performed to estimate the rate ratios adjusted for age, estimated glomerular filtration rate (eGFR), and urinary protein levels.Results　The 4-year cumulative rate of dialysis initiation was 40.1 per 100,000 among those who underwent specific health checkups compared to 423.7 per 100,000 among those who did not. The rate of dialysis initiation was significantly higher among individuals with eGFR <45 and urinary protein ≥2+. Additionally，hypertension and diabetes mellitus were significant associated factors, with the rate ratios of 3.87 (95% CI: 1.37-10.9) and 7.51 (95% CI: 3.05-18.5), respectively.Conclusion　These findings highlight an urgent need to improve health check-up participation rates to identify high-risk individuals and to prevent disease progression. This study also underscores the importance of addressing diabetes and other associated factors in CKD management, which may lead to the development of targeted health initiatives by NHI insurers.