HOSHINO Junichi    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor and Division head
Article types	Original article
Language	English
Peer review	Non peer reviewed
Title	Public support for patients with intractable diseases in Japan: impact on clinical indicators from nationwide registries in patients with autosomal dominant polycystic kidney disease.
Journal	Formal name：Clinical and experimental nephrology Abbreviation：Clin Exp Nephrol ISSN code：14377799/13421751
Volume, Issue, Page	27(10),pp.809-818
Author and coauthor	Kataoka Hiroshi, Shimada Yosuke, Nishio Saori, Nakatani Shinya, Mochizuki Toshio, Tsuchiya Ken, Hoshino Junichi, Hattanda Fumihiko, Kawano Haruna, Hanaoka Kazushige, Hidaka Sumi, Ichikawa Daisuke, Ishikawa Eiji, Uchiyama Kiyotaka, Hayashi Hiroki, Makabe Shiho, Manabe Shun, Mitobe Michihiro, Sekine Akinari, Suwabe Tatsuya, Kai Hirayasu, Kurashige Mahiro, Seta Koichi, Shimazu Keiji, Moriyama Tomofumi, Sato Mai, Otsuka Tadashi, Katayama Kan, Shimabukuro Wataru, Fujimaru Takuya, Miura Kenichiro, Nakanishi Koichi, Horie Shigeo, Furuichi Kengo, Okada Hirokazu, Narita Ichiei, Muto Satoru
Publication date	2023/10
Summary	BACKGROUND:Clinical practice guidelines recommend antihypertensive and tolvaptan therapies for patients with autosomal dominant polycystic kidney disease (ADPKD) in Japan. However, tolvaptan therapy may pose an economic burden. The Japanese Ministry of Health, Labour and Welfare supports patients with intractable diseases. This study aimed to confirm the impact of the intractable disease system in Japan on the clinical treatment of ADPKD.METHODS:We analyzed the data of 3768 patients with ADPKD having a medical subsidy certificate from the Japanese Ministry of Health, Labour and Welfare in 2015-2016. The following quality indicators were use: the adherence rate to the 2014 clinical practice guideline for polycystic kidney disease (prescription rates of antihypertensive agents and tolvaptan in this cohort) and the number of Japanese patients with ADPKD nationwide started on renal replacement therapy in 2014 and 2020.RESULTS:Compared with new applications from 2015 to 2016, the prescription rates of antihypertensives and tolvaptan for the indicated patients at the 2017 renewal application increased by 2.0% (odds ratio = 1.41, p = 0.008) and 47.4% (odds ratio = 10.1, p > 0.001), respectively. These quality indicators improved with antihypertensive treatment, especially in patients with chronic kidney disease stages 1-2 (odds ratio = 1.79, p = 0.013) and in those aged < 50 years (odds ratio = 1.70, p = 0.003). The number of patients with ADPKD who were started on renal replacement therapy in Japan decreased from 999 in 2014 to 884 in 2020 in the nationwide database (odds ratio = 0.83, p < 0.001).CONCLUSIONS:The Japanese public intractable disease support system contributes to improvement of ADPKD treatment.
DOI	10.1007/s10157-023-02372-8
PMID	37368094