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Affiliation |
Faculty of Medicine School of Medicine Department of Social Medicine, Public Health |
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Title |
Professor |
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Related SDGs |
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IKENOUE Tatsuyoshi
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Papers 【 display / non-display 】
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Kobayashi A., Hirano K., Okuda T., Ikenoue T., Yamada Y., Yokoo T., Fukuma S.
Clinical and Experimental Nephrology 30 ( 3 ) 388 - 396 2026.3
Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical and Experimental Nephrology
Background: The risk of mortality and cardiovascular disease (CVD) may be higher among some super-older adults with chronic kidney disease (CKD). We assessed outcomes across CKD stages in an aging Japanese population. Methods: This retrospective cohort study using nationwide health examination and insurance claims database enrolled individuals aged 75–90 years whose renal function was measured > 2 times during the observation period. CKD stages were classified using eGFR and urinary protein levels. We used a Cox proportional hazards model to evaluate all-cause mortality and CVD events by CKD stage and a logistic regression model to assess dialysis initiation by renal function and proteinuria among patients with advanced CKD. Results: Of 365,664 individuals aged 75–90 years, > 30% met the CKD diagnosis criteria, mostly the CKD G3aA1 category. During follow-up, 18,238 deaths and 48,937 CVD events occurred. Mortality and CVD incidence increased with advancing CKD stages. Mortality risk was elevated only among G3a patients with urinary protein (A2/3: HR 1.64 [95% CI 1.53–1.76]), but not without (A1: HR 1.01 [0.97–1.05]). CVD risk increased significantly across all A2/3 stages, but not in A1. Dialysis was initiated in 9.5% of patients with CKD G4/5, with an earlier risk observed in the A2/3 group. Conclusion: In older adults, CKD prognosis varies according to stage and proteinuria. Most individuals with early-stage, proteinuria-negative CKD do not experience adverse outcomes, whereas trace or greater proteinuria indicates higher risk. Outcome-based CKD management in a super-older population is essential to avoid overtreatment and ensure appropriate care.
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Kobayashi A., Ohnishi T., Okuda T., Hirano K., Ikenoue T., Yokoo T., Fukuma S.
BMC Nephrology 26 ( 1 ) 2025.12
Language：English Publishing type：Research paper (scientific journal) Publisher：BMC Nephrology
Background: Chronic kidney disease (CKD) is a significant global health concern, with increasing focus on predicting renal prognosis. While renal prognosis is often studied in advanced CKD, variability in renal function and its implications for long-term outcomes in early-stage CKD remain insufficiently examined. This study aimed to investigate renal prognosis in early-stage CKD within the general population, focusing on patterns of renal function variability and factors associated with high variability. Methods: This retrospective nationwide cohort study included participants from various geographical regions across Japan. A total of 1,765 adults with early-stage CKD (eGFR 45–59 mL/min/1.73 m<sup>2</sup>), based on two initial screening results, were analyzed. The primary outcome was the pattern of eGFR variability identified by cluster analysis using three parameters: mean residual (difference between linear prediction and observed value), maximum residual, and range. In addition, we used a logistic regression model in order to assess associations between clinical factors and the high-risk cluster. Results: We identified three distinct clusters based on eGFR variability using cluster analysis. Among these clusters, one exhibited significantly high variability with a high residual (median of mean residuals of 10.9 mL/min/1.73 m<sup>2</sup> and median of maximum residuals of 22.6 mL/min/1.73 m<sup>2</sup>) and a wide range (median of range of 25.1 mL/min/1.73 m<sup>2</sup>) (referred to as the "high variability cluster"). This cluster, comprising 4.6% of patients with early-stage CKD, demonstrated a more pronounced decline in eGFR over time. Factors such as younger age, proteinuria, antihypertensive drug use, and hyperglycemia were associated with the high variability cluster. Conclusions: This study highlights the presence of distinct eGFR variability patterns in early-stage CKD and identifies a subgroup at high risk for rapid renal decline. Monitoring eGFR variability provides critical insights into long-term prognosis and may inform targeted interventions. Considering these findings, early detection and management of patients with early CKD may improve disease progression and reduce the risk of adverse outcomes. Trial registration: This study is an observational study using a database and does not involve a health care intervention on human participants. Therefore, trial registration is not applicable.
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Oku K., Yamada H., Ikenoue T., Akizuki M., Hagiyama H., Ideguchi H., Ihata A., Kakutani T., Kawahata K., Matsui T., Obata J., Ohno S., Sato S., Sawa N., Suda A., Taguchi H., Takeno M., Ueda A., Yamasaki M., Yamaoka K.
Modern Rheumatology 35 ( 6 ) 997 - 1008 2025.11
Language：English Publishing type：Research paper (scientific journal) Publisher：Modern Rheumatology
Objectives To evaluate vaccination rates and identify factors associated with vaccine uptake among patients with autoimmune inflammatory rheumatic diseases (AIRD) in Kanagawa Prefecture, Japan. Methods An anonymous survey was conducted between January and May 2023 using Google Forms™. Adult AIRD patients and rheumatologists were asked about demographics, disease characteristics, vaccination status, and attitudes towards vaccination. Logistic regression and random forest analyses were used to identify factors influencing vaccination rates. Results A total of 1 637 AIRD patients responded. Vaccination rates were as follows: herpes zoster 8.8%, influenza 86.7%, pneumococcus 29.7%, human papillomavirus 4.3%, hepatitis B virus 8.7%, and severe acute respiratory syndrome corona virus-2 92.2%. Physician recommendations were significantly associated with higher vaccination rates. Although knowledge of vaccine efficacy correlated with increased uptake, it did not fully alleviate vaccine hesitancy. Major barriers included concerns about adverse effects and lack of sufficient information. Conclusions Physician recommendations and providing comprehensive vaccine information are essential for improving vaccination rates among AIRD patients. Addressing concerns about vaccine safety and efficacy through targeted educational interventions and communication strategies is crucial to enhancing vaccine uptake.
DOI： 10.1093/mr/roaf061
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Comprehensive Conservative Kidney Management among Older Population Reviewed
Kobayashi A., Hirano K., Okuda T., Ikenoue T., Yamada Y., Yokoo T., Fukuma S.
Kidney360 6 ( 10 ) 1713 - 1721 2025.10
Language：English Publishing type：Research paper (scientific journal) Publisher：Kidney360
Key Points – Nonfrail patients age 75 years and older with advanced CKD were more likely to select conservative kidney management (CKM).The CKM group had significantly lower hospitalization rates compared with the non-CKM group in older patients with advanced CKD.Mortality outcomes were comparable between the CKM and non-CKM groups, indicating no notable survival disadvantage with CKM.Background – In an aging society, conservative kidney management (CKM) has emerged as an alternative to KRT for older patients with advanced CKD. However, current evidence regarding CKM selection and its outcomes is limited. This study compared the rates of hospitalization and survival in CKM patients with those of KRT in the older Japanese general population with advanced CKD.Methods – Using a large administrative claims database, we identified individuals age 75 years or older with an eGFR <8 ml/min per 1.73 m<sup>2</sup> who were not receiving KRT at a health checkup. Patients were classified into two groups: CKM and non-CKM. The CKM group comprised those who did not undergo any procedures related to KRT induction for the entire observation period, whereas those who received these procedures were classified into the non-CKM group. A Cox regression model was used to evaluate factors associated with the CKM selection and survival outcomes. A Poisson regression model was used to evaluate incidence rate ratios for hospitalization.Results – A total of 428 patients with a median age of 81.0 years (interquartile range, 77.8–84.9) were included. Of them, 307 (71.7%) were assigned to the CKM group. CKM selection was more prevalent among nonfrail individuals (hazard ratio, 1.56; 95% confidence interval [CI], 1.23 to 2.00). The CKM group demonstrated a significantly lower hospitalization rate (adjusted incidence rate ratios, 0.40; 95% CI, 0.32 to 0.49). Notably, the mortality rates did not differ significantly between the two groups (hazard ratio, 0.84; 95% CI, 0.45 to 1.56).Conclusions – CKM was more commonly chosen by nonfrail patients with advanced CKD. The CKM group had significantly fewer hospitalizations than the non-CKM group without any detrimental effect on survival rate. These findings highlight the potential benefits of CKM and the need for further studies to improve CKM indications in aging populations.
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Current practice variations in venous thromboembolism prophylaxis for adolescents with severe traumatic brain injury: Trauma center type matters Reviewed International coauthorship
Katsura M., Fukuma S., Miyata S., Ikenoue T., Daggupati S., Martin M.J., Inaba K., Matsushima K.
Journal of Trauma and Acute Care Surgery 99 ( 3 ) 373 - 381 2025.9
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Trauma and Acute Care Surgery
BACKGROUND While severe traumatic brain injury (TBI) faces an increased risk of venous thromboembolism (VTE), pharmacological VTE prophylaxis might be significantly delayed because of concerns for TBI progression. We aimed to assess practice variations in the rate and timing of VTE prophylaxis for adolescent patients with severe TBI between different trauma center types. METHODS This retrospective cohort study using the American College of Surgeon Trauma Quality Improvement Program database (2017-2021) included patients aged 14 to 18 years with severe TBI. Trauma centers were classified as follows: adult trauma center (ATC), mixed trauma center (MTC), and pediatric trauma center (PTC). We developed a multilevel mixed-effect Poisson regression model to assess the association between trauma center type and the rate and timing of VTE prophylaxis. Effect sizes for fixed effects were reported as adjusted incidence rate ratio (aIRR) with 95% confidence interval (CI). Secondary outcomes included the incidence of VTE and late neurosurgical interventions (>72 hours). RESULTS Of 7,238 eligible patients, pharmacological VTE prophylaxis was performed in 63.1% at ATC, 59.0% at MTC, and 28.5% at PTC. The median time to the initial prophylaxis was 4 days at ATC, 4 days at MTC, and 6 days at PTC (p < 0.001). In the regression model, treatment at MTC and PTC was associated with decreased likelihood of VTE prophylaxis (aIRR, 0.89 [95% CI, 0.80-0.97] and aIRR, 0.39 [95% CI, 0.32-0.47]) compared with ATC. Treatment at PTC was associated with higher odds of VTE events (odds ratio, 2.04; 95% CI, 1.16-3.60), while there was no significant difference in the rate of late neurosurgical interventions between ATC and PTC (odds ratio, 1.18; 95% CI, 0.68-2.05). CONCLUSION We observed significant practice variations in the use of pharmacological VTE prophylaxis for adolescent patients with severe TBI between ATC, MTC, and PTC. Further research is warranted to investigate potential drivers of these variations and develop standardized protocols. LEVEL OF EVIDENCE Therapeutic/Care management; Level III.