Current Situation of Chronic Kidney Disease Management in General Practice in Japan: A Questionnaire Survey for General Physicians.

Total management of chronic kidney disease has been well established, and the screening using dipstick urine test has already been widespread in Japan. Nevertheless, the number of dialysis patients is still rising. While clinical cooperation between general physicians and nephrologists is expected to improve prognoses of chronic kidney disease patients, real situation of the management in general practice has not been obvious. We conducted a questionnaire survey for the doctors of Hyogo Prefecture Medical Association excluding nephrologists to clarify the situation and the issue about chronic kidney disease management in general practice. Total 169 doctors replied to the questionnaire. In 74.0% of medical facilities, estimated glomerular filtration rate was automatically calculated and indicated in the result report with the measurement of serum creatinine. The compliance rates of the chronic kidney disease clinical guideline for Japanese regarding referral to nephrologists were 33.7% in cases of urine abnormality and 57.4% in cases of decreased kidney function. For the patients of diabetes without previous diagnosis of nephropathy, only 30.8% of doctors examined urine albumin at least every 6 months. In general practice, there is still much possibility to improve chronic kidney disease management. We have to continue to advocate the significance of clinical cooperation between general physicians and nephrologists, with high level of evidence.