NATIONWIDE QUESTIONNAIRE ANLYSIS ON AWARENESS OF GENERAL PRACTITIONERS FOR THE MANAGEMENT OF CHRONIC KIDNEY DISEASE IN JAPAN

 

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https://storage.unitedwebnetwork.com/files/1099/8b708c885eb55409c07521144effdd14.pdf
NATIONWIDE QUESTIONNAIRE ANLYSIS ON AWARENESS OF GENERAL PRACTITIONERS FOR THE MANAGEMENT OF CHRONIC KIDNEY DISEASE IN JAPAN

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Kazuo
Kobayashi
Kazuo Kobayashi k-taishi@xc4.so-net.ne.jp Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan *
Satoru Tatematsu satoruz_t@yahoo.co.jp Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan -
Tsuguru Hatta tsuguhatta@hotmail.com Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan -
Taisuke Isozaki isozakit73@gmail.com Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan -
Yosuke Nakayama nakayama@ser.bbiq.jp Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan -
Junko Imura 8879imujun@gmail.com Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan -
Toshimasa Takahashi ttyt1235@gmail.com Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan -
Munehiro Kitada kitta@ishinkai-med.com Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan -
Masanobu Miyazaki msnbmiya@gmail.com Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan -
Yasunori Utsunomiya ysnr-1208@nifty.com Japan Physicians Association Committee of Kidney and Electrolyte Disease Tokyo Japan -
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Managing a large number of patients with chronic kidney disease (CKD) requires collaboration with nephrologists and general practitioners (GPs), therefore, the quality of standard CKD care provided by GPs and appropriate cooperation with nephrologists are required. In 2024, the Japan Physicians Association conducted the third nationwide questionnaire survey on the management of CKD to clarify current issues in the awareness of CKD medical care in Japan.

In the 2024 surveys, 1003 GPs who voluntarily participated answered 20 questions regarding CKD care and treatment. GPs were divided into two groups; 835 non-specialists and 168 nephrologists and the differences were analyzed. Further, regarding ten questions, the comparison among non-specialists between the 2025 survey and past two surveys that we conducted in 2013 (n=2021), and 2019 (n=525). 

The prevalence of having/ using CKD guidelines were significantly lower in non-specialists than not only nephrologists (55%/21% and 86%/60%, respectively, p<0.001), but also those in the past two surveys (p<0.001). Although eGFR assessment was widespread at 95%, quantitative proteinuria measurement was significantly lower 34% of non-specialists than 82% of nephrologists, respectively, p<0.001). This prevalence has decreased with each survey, and with the age of non-specialists. While 75% of nephrologists answered to using renin-angiotensin system inhibitors continuously for patients with CKD and hypertension considering its reno-protective effects, however, 45% of non-nephrologists answered it (p<0.001). The prevalence of non-specialists who responded to evaluate not only BP in the office but also at home on the management of CKD was 54.0% in the 2013 survey, but has increased with each survey, reaching to 84.8% in the 2024 survey (p<0.001). Regarding the use of RAS inhibitors to patients with CKD and hypertension, the 2024 survey showed an increase in the numbers of respondents who use RAS inhibitors to patients with proteinuria, while the number of respondents who do not use RAS inhibitors decreased compared to the 2019 survey (p=0.002). Regarding the use of erythropoietin stimulating agents, 62% of non-specialists and 83% of nephrologists prescribed them at their own discretion (p<0.001). The prevalence of non-specialists with a target hemoglobin of over 11g/dl for the management of renal anemia significantly increased from 8% in the 2019 survey to 32% in the 2025 survey (p<0.001). While 61% of non-specialists answered to prescribe sodium-glucose transporter 2 inhibitors to patients with CKD regardless of the complication of diabetes, 83% of nephrologists answered it (p<0.001).

The quality of the management of CKD by GPs has improved in the past decade, however, the low utilization of guidelines and the low implementation of quantitative proteinuria measurement among non-specialists, especially orderly GPs, are issues that need to be resolved in the future.

 

Kewords