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Kidney and Cardiovascular Outcomes by Chronic Kidney Disease Stage and Etiology of Chronic Kidney Disease: A Randomly

Ryoya Tsunoda1, Tomohiro Ohigashi2, Junichi Hoshino3

  • 1Department of Nephrology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.

American Journal of Nephrology
|July 10, 2026
PubMed

Insights

Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease, but polycystic kidney disease (PKD) most frequently leads to dialysis in advanced stages. Non-proteinuric nephrosclerosis (NSc) shows a low risk for end-stage kidney disease.

Area of Science:

  • Nephrology
  • Chronic Kidney Disease Epidemiology
  • Public Health

Background:

  • Kidney disease management is a global health priority.
  • Identifying primary causes of end-stage kidney disease (ESKD) is crucial for effective interventions.

Purpose of the Study:

  • To investigate the primary etiologies of chronic kidney disease (CKD) in a Japanese cohort.
  • To analyze the progression rates and outcomes associated with different CKD etiologies.

Main Methods:

  • Established the nationwide REACH-J chronic kidney disease (CKD) cohort.
  • Enrolled 2,249 patients with CKD stages G3b-G5 across 31 institutions.
  • Collected data on lifestyle, medical history, and followed patients for 5 years.

Main Results:

  • Diabetic kidney disease (DKD) was the most common etiology (24.5%), followed by nephrosclerosis (NSc; 24.4%).
  • Kidney replacement therapy (KRT) initiation rates were highest for DKD in early stages (G3b) and for polycystic kidney disease (PKD) in advanced stages (G4/G5).
  • NSc showed consistently low KRT initiation rates, and higher proteinuria predicted poorer renal outcomes.

Conclusions:

  • While DKD is the leading cause of ESKD globally, PKD drives dialysis initiation in advanced CKD stages 4-5.
  • Non-proteinuric NSc demonstrates a very low risk of ESKD progression, even in advanced CKD stages (G3b-G5).
Abstract

Keywords:
All-cause mortalityChronic kidney diseaseDiabetic kidney diseaseEnd-stage kidney diseaseREACH-J

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