Am J Nephrol. 2026 Jul 10:1-27. doi: 10.1159/000553499. Online ahead of print.
ABSTRACT
INTRODUCTION: Countermeasures against kidney disease are recognized worldwide as an important health management issue. Accurate identification and examination of the primary diseases that lead to end-stage kidney disease are crucial.
METHODS: We established the REACH-J cohort, a nationwide chronic kidney disease (CKD) cohort using a random sampling method including 31 medical institutions. Patients with CKD stage G3b-G5 were enrolled and completed surveys on lifestyle and medical visits; institutions provided data on patient medical history with a 5-year follow-up.
RESULTS: Among 2,249 patients (mean age, 69.1 ± 12.6 years), primary CKD etiologies were diabetic kidney disease (DKD; 24.5%), nephrosclerosis (NSc; 24.4%), polycystic kidney disease (PKD; 5.8%), and others (45.3%). Event rates (per 100 person-years) were 3.0 for all-cause mortality, 2.0 for pre-kidney replacement therapy (KRT) death, and 8.4 for KRT initiation. DKD has the highest KRT initiation patients stage G3b, whereas PKD had the highest rate in stages G4/G5. NSc consistently had the lowest KRT initiation rates. Mortality was highest in DKD in stage G3b, followed by Nsc. Kaplan-Meier analysis showed an early KRT initiation rate in DKD, later surpassed by PKD. Across etiologies, higher proteinuria predicted poorer renal outcomes, while cardiovascular and mortality rates did not differ by proteinuria stage.
CONCLUSIONS: Although DKD is the leading cause of end-stage kidney disease worldwide, PKD most commonly led to dialysis in patients with CKD stages 4-5. In contrast, non-proteinuric NSc conferred a very low risk of end-stage kidney disease even in advanced CKD (G3b-G5).
PMID:42430293 | DOI:10.1159/000553499