# Management status of patients with chronic kidney disease across medical specialties in Japan: a real-world data analysis

## TL;DR

This study examines how chronic kidney disease is managed across different medical specialties in Japan using real-world data.

## Contribution

The study reveals significant variability in CKD management and highlights the underutilization of nephrology care.

## Key findings

- Only 1.2% of patients with suspected CKD received care in a nephrology department.
- Nephrology involvement led to more frequent urine protein assessments and earlier CKD diagnosis in other specialties.
- Interdepartmental collaboration and standardized protocols are recommended to improve early CKD detection.

## Abstract

Chronic kidney disease (CKD) contributes to poor renal and cardiovascular outcomes, necessitating early detection and intervention. The current study investigated the variability in CKD management practices across clinical specialties in Japan. Real-world electronic health records of 788,059 patients with suspected CKD between January 2004 and September 2021 were analyzed. Only 1.2% of patients received care in a nephrology department. However, nephrology involvement significantly increased the proportion of patients undergoing quantitative urine protein assessments and receiving a CKD diagnosis. This trend was evident in cardiology, urology, rheumatology, and endocrinology/metabolism departments, where nephrology involvement resulted in more frequent testing and earlier CKD diagnosis. Despite these benefits, the overall proportion of patients with nephrology involvement remains low, especially in the early stages of CKD. These findings highlight the considerable variability in CKD diagnosis and management approaches across clinical departments. Because quantitative urine protein assessment is critical for precise CKD diagnosis and patient care, strategies such as promoting interdepartmental collaboration with nephrology departments and establishing standardized diagnostic protocols tailored to individual specialties and facilities should be prioritized. Implementing such facility- and specialty-specific measures is crucial for enhancing early CKD detection and intervention, ultimately improving clinical outcomes in patients at risk of CKD progression.

The online version contains supplementary material available at 10.1038/s41598-025-31735-2.