J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 12, Number 2, February 2020, pages 115-121

Medical and Dental Visits of Chronic Kidney Disease-Diagnosed Participants Analyzed From the Specific Health Checkups Results in Japan: TAMA MED Project-CKD

Figure 1. The rates of regular visits at medical institutions of participants undergoing health checkups from 2013 to 2015. Left: all medical institutions; right: medical institutions specializing in internal medicine. •: very high risk; ○: high risk; ▲: moderately increased risk; ■: low risk or no CKD. n = 12,732 (2013), n = 14,150 (2014), and n = 12,274 (2015). CKD: chronic kidney disease.

Figure 2. The rates of dental visits of CKD-diagnosed participants from 2013 to 2015 compared to the rates of regular visits at medical institutions specializing in internal medicine. Left: medical institutions specializing in internal medicine; right: dental clinics. •: very high risk; ▲: moderately increased risk. Very high risk: n = 141 (2013), n = 127 (2014), and n = 115 (2015); moderately increased risk: n = 2,056 (2013), n = 2,044 (2014), and n = 1,981 (2015). *P < 0.05; **P < 0.01 versus moderately increased risk. CKD: chronic kidney disease.

Figure 3. The rates of dental visits of CKD-diagnosed participants depending on the degree of impaired glucose tolerance from 2013 to 2015. (a) The rates of dental visits of CKD moderately increased risk group. •: Moderately increased risk with HbA1c ≤ 6.0 and FPG ≤ 120 mg/dL and not receiving medical treatment for diabetes: non-impaired glucose tolerance; ○: moderately increased risk with HbA1c > 6.0 or FPG > 120 mg/dL; ▲: moderately increased risk with HbA1c > 7.0 or FPG > 140 mg/dL. *P < 0.05; **P < 0.01 versus non-impaired glucose tolerance. (b) The rates of dental visits of CKD very high risk group. •: very high risk with HbA1c ≤ 6.0 and FPG ≤ 12 0 mg/dL and not receiving medical treatment for diabetes: non-impaired glucose tolerance; ○: very high risk with HbA1c > 6.0 or FPG > 120 mg/dL; ▲: very high risk with HbA1c > 7.0 or FPG > 140 mg/dL. CKD: chronic kidney disease; HbA1c: hemoglobin A1c; FPG: fasting plasma glucose.

**Table 1.** Characteristics of Participants
Data are given as n (%) or mean ± SD. BMI: body mass index; BP: blood pressure; TIA: transient ischemic attack; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; NGSP: National Glycohemoglobin Standardization Program; JDS: Japan Diabetes Society; AF: atrial fibrillation; EKG: electrocardiogram. ^aCardiac disease was self-reported. ^bHbA1c (JDS) + 0.4%.
Number of subjects	12,303
Age (years)	67.0 ± 7.3
Sex: men, women (%)	5,034 (40.9), 7,269 (59.1)
BMI (kg/m²)	22.6 ± 3.3
Systolic BP (mm Hg)	127.2 ± 16.5
Diastolic BP (mm Hg)	74.5 ± 10.4
Current smoker	2,697 (22.2)
Comorbidities
Cardiac disease^a	749 (6.1)
Hypertension	5,235 (42.6)
Diabetes mellitus	1,603 (13.0)
Stroke/TIA	488 (4.0)
Metabolic syndrome	1,837 (14.9)
Blood examinations
HDL-C (mg/dL)	64.5 ± 16.6
LDL-C (mg/dL)	124.6 ± 30.4
Triglycerides (mg/dL)	114.4 ± 80.1
HbA1c (NGSP)^b (%)	5.7 ± 0.6
Urinalysis
Urine sugar	280 (2.3)
Urine protein	517 (4.2)
EKG
AF	175 (1.4)
Medications
For hypertension	4,206 (34.2)
For diabetes mellitus	1,011 (8.2)
For dyslipidemia	2,693 (21.9)

Table 1. Characteristics of Participants

Data are given as n (%) or mean ± SD. BMI: body mass index; BP: blood pressure; TIA: transient ischemic attack; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; NGSP: National Glycohemoglobin Standardization Program; JDS: Japan Diabetes Society; AF: atrial fibrillation; EKG: electrocardiogram. ^aCardiac disease was self-reported. ^bHbA1c (JDS) + 0.4%.

Number of subjects

12,303

Age (years)

67.0 ± 7.3

Sex: men, women (%)

5,034 (40.9), 7,269 (59.1)

BMI (kg/m²)

22.6 ± 3.3

Systolic BP (mm Hg)

127.2 ± 16.5

Diastolic BP (mm Hg)

74.5 ± 10.4

Current smoker

2,697 (22.2)

Comorbidities

Cardiac disease^a

749 (6.1)

Hypertension

5,235 (42.6)

Diabetes mellitus

1,603 (13.0)

Stroke/TIA

488 (4.0)

Metabolic syndrome

1,837 (14.9)

Blood examinations

HDL-C (mg/dL)

64.5 ± 16.6

LDL-C (mg/dL)

124.6 ± 30.4

Triglycerides (mg/dL)

114.4 ± 80.1

HbA1c (NGSP)^b (%)

5.7 ± 0.6

Urinalysis

Urine sugar

280 (2.3)

Urine protein

517 (4.2)

EKG

175 (1.4)

Medications

For hypertension

4,206 (34.2)

For diabetes mellitus

1,011 (8.2)

For dyslipidemia

2,693 (21.9)

**Table 2.** Classification of CKD-Diagnosed Participants That Attended Checkups in 2015
GFR stage	eGFR (mL/min/1.73m²)	Proteinuria (-) or (±)	Proteinuria (+)	Proteinuria (++) or (+++)	Unknown
Red: very high risk; orange: high risk; yellow: moderately increased risk; green: low risk or no CKD.
G1 (risk)	≥ 90	1,264 (green)	46 (yellow)	10 (orange)	5
G2 (risk)	60 - 89	8,597 (green)	217 (yellow)	52 (orange)	9
G3a (risk)	45 - 59	1,718 (yellow)	85 (orange)	38 (red)	1
G3b (risk)	30 - 44	170 (orange)	24 (red)	17 (red)	0
G4 (risk)	15 - 29	8 (red)	9 (red)	15 (red)	0
G5 (risk)	< 15	0 (red)	2 (red)	2 (red)	14 (dialysis)

Table 2. Classification of CKD-Diagnosed Participants That Attended Checkups in 2015

GFR stage

eGFR (mL/min/1.73m²)

Proteinuria (-) or (±)

Proteinuria (+)

Proteinuria (++) or (+++)

Unknown

Red: very high risk; orange: high risk; yellow: moderately increased risk; green: low risk or no CKD.

G1 (risk)

≥ 90

1,264 (green)

46 (yellow)

10 (orange)

G2 (risk)

60 - 89

8,597 (green)

217 (yellow)

52 (orange)

G3a (risk)

45 - 59

1,718 (yellow)

85 (orange)

38 (red)

G3b (risk)

30 - 44

170 (orange)

24 (red)

17 (red)

G4 (risk)

15 - 29

8 (red)

9 (red)

15 (red)

G5 (risk)

< 15

0 (red)

2 (red)

14 (dialysis)

**Table 3.** Amount of People With Risk Factors for Lifestyle Diseases That Attended Checkups in 2015
GFR stage	HT	DM	HL	BMI ≥ 25	BMI < 18.5	Smoking
Hypertension was defined by a systolic BP ≥ 140 mm Hg and/or receiving antihypertensive medication; diabetes mellitus was defined by an FPG ≥ 126 mg/dL or HbA1c ≥ 6.5% (NGSP), and/or receiving medical treatment with oral hypoglycemic agents and/or insulin; hyperlipidemia was defined by an LDL-C ≥ 140 mg/dL and/or receiving antihyperlipidemic medication. BP: blood pressure; HT: hypertension; DM: diabetes mellitus; HL: hyperlipidemia; BMI: body mass index; NGSP: National Glycohemoglobin Standardization Program; GFR: glomerular filtration rate; FPG: fasting plasma glucose; LDL-C: low-density lipoprotein cholesterol.
G1 ( n = 1,325)	518 (39.0%)	135 (10.2%)	190 (14.3%)	123 (9.3%)	517 (39.0%)	282 (21.3%)	247 (18.6%)	172 (13.0%)	365 (27.5%)
G2 (n = 8,875)	3,848 (43.4%)	1,027 (11.6%)	1,038 (11.7%)	625 (7.0%)	4,303 (48.5%)	2,429 (27.4%)	1,789 (20.2%)	806 (9.1%)	1,872 (21.1%)
G3a (n = 1,842)	1,024 (55.6%)	197 (10.7%)	272 (14.8%)	144 (7.8%)	967 (52.5%)	472 (25.6%)	428 (23.2%)	117 (6.4%)	380 (20.6%)
G3b (n = 211)	152 (72.0%)	13 (6.2%)	49 (23.2%)	30 (14.2%)	114 (54.0%)	37 (17.5%)	79 (37.4%)	9 (4.3%)	62 (29.4%)
G4 (n = 32)	23 (71.9%)	3 (9.4%)	14 (43.8%)	2 (6.3%)	18 (56.3%)	8 (25%)	13 (40.6%)	2 (6.3%)	15 (46.9%)
G5 (n = 18)	16 (88.9%)	0 (0%)	5 (27.8%)	0 (0%)	4 (22.2%)	2 (11.1%)	7 (38.9%)	5 (27.8%)	3 (16.7%)

Table 3. Amount of People With Risk Factors for Lifestyle Diseases That Attended Checkups in 2015

GFR stage

BMI ≥ 25

BMI < 18.5

Smoking

All

Medication (-)

All

Medication (-)

All

Medication (-)

Hypertension was defined by a systolic BP ≥ 140 mm Hg and/or receiving antihypertensive medication; diabetes mellitus was defined by an FPG ≥ 126 mg/dL or HbA1c ≥ 6.5% (NGSP), and/or receiving medical treatment with oral hypoglycemic agents and/or insulin; hyperlipidemia was defined by an LDL-C ≥ 140 mg/dL and/or receiving antihyperlipidemic medication. BP: blood pressure; HT: hypertension; DM: diabetes mellitus; HL: hyperlipidemia; BMI: body mass index; NGSP: National Glycohemoglobin Standardization Program; GFR: glomerular filtration rate; FPG: fasting plasma glucose; LDL-C: low-density lipoprotein cholesterol.

G1 ( n = 1,325)

518 (39.0%)

135 (10.2%)

190 (14.3%)

123 (9.3%)

517 (39.0%)

282 (21.3%)

247 (18.6%)

172 (13.0%)

365 (27.5%)

G2 (n = 8,875)

3,848 (43.4%)

1,027 (11.6%)

1,038 (11.7%)

625 (7.0%)

4,303 (48.5%)

2,429 (27.4%)

1,789 (20.2%)

806 (9.1%)

1,872 (21.1%)

G3a (n = 1,842)

1,024 (55.6%)

197 (10.7%)

272 (14.8%)

144 (7.8%)

967 (52.5%)

472 (25.6%)

428 (23.2%)

117 (6.4%)

380 (20.6%)

G3b (n = 211)

152 (72.0%)

13 (6.2%)

49 (23.2%)

30 (14.2%)

114 (54.0%)

37 (17.5%)

79 (37.4%)

9 (4.3%)

62 (29.4%)

G4 (n = 32)

23 (71.9%)

3 (9.4%)

14 (43.8%)

2 (6.3%)

18 (56.3%)

8 (25%)

13 (40.6%)

2 (6.3%)

15 (46.9%)

G5 (n = 18)

16 (88.9%)

0 (0%)

5 (27.8%)

0 (0%)

4 (22.2%)

2 (11.1%)

7 (38.9%)

5 (27.8%)

3 (16.7%)