Effects of a cooperative clinical pathway on chronic kidney disease (CKD) in Kamiamakusa City, Kumamoto, Japan

Abstract

The number of dialysis patients has been increasing in Japan, reaching 290,675 patients in total, or 2,279.6 patients per million, in 2009 ¹⁾. Kumamoto prefecture reports one of the highest number of dialysis patients per million in Japan. Kamiamakusa city ranked 4th in Kumamoto in 2006, making it a city where effective measures urgently needed to be taken against chronic kidney disease (CKD). The department of kidney disease was established at Saiseikai Misumi Hospital (Misumi, Kumamoto) in 2007 so that chronic renal failure could be managed by dialysists and nephrologists in accordance with guidelines on CKD. We developed a cooperative clinical pathway for CKD in Kumamoto in collaboration with local general practitioners, and the pathway became available in 2009. We also began to perform statistical analysis to identify predictive factors for advanced renal failure. We followed up on 63 patients, 39 within the cooperative clinical pathway and 24 of whom were regular outpatients, during the observation period from April, 2009 to July, 2010 (16 months). Renal sclerosis was the highest original cause of renal failure, followed by chronic glomerulonephritis and diabetic nephropathy. The clinical outcome was defined by serum creatinine, estimated GFR (eGFR), stage of CKD, and the ratio of urinary protein/urinary creatinine. A significant relationship between urinary protein and CKD progression was demonstrated (p<0.05) whereas no significant relationship was shown between hypertension and eGFR. The cooperative clinical pathway for CKD in collaboration with local general practitioners helped prevent both renal failure and the need for patients to begin dialysis, and we believe it necessary that this clinical pathway continue to be made available.