Public support for patients with intractable diseases in Japan: impact on clinical indicators from nationwide registries in patients with autosomal dominant polycystic kidney disease

Hiroshi Kataoka, Yosuke Shimada, Saori Nishio, Shinya Nakatani, Toshio Mochizuki, Ken Tsuchiya, Junichi Hoshino, Fumihiko Hattanda, Haruna Kawano, Kazushige Hanaoka, Sumi Hidaka, Daisuke Ichikawa, Eiji Ishikawa, Kiyotaka Uchiyama, Hiroki Hayashi, Shiho Makabe, Shun Manabe, Michihiro Mitobe, Akinari Sekine, Tatsuya SuwabeHirayasu Kai, Mahiro Kurashige, Koichi Seta, Keiji Shimazu, Tomofumi Moriyama, Mai Sato, Tadashi Otsuka, Kan Katayama, Wataru Shimabukuro, Takuya Fujimaru, Kenichiro Miura, Koichi Nakanishi, Shigeo Horie, Kengo Furuichi, Hirokazu Okada, Ichiei Narita, Satoru Muto

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)809-818
Number of pages10
JournalClinical and Experimental Nephrology
Volume27
Issue number10
DOIs
Publication statusPublished - 10-2023

All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

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