Those who avoid further examination follow the Markov model. The third chance node divides participants who underwent further examination into those who undergo treatment of CKD and those left untreated. We derived these probabilities by initial renal function stratum with
a Delphi survey of the expert committee. Regarding the strata of stage 3 CKD, a cut-off value of eGFR (50 ml/min/1.73 m2) and comorbidity such as hypertension, diabetes and/or hyperlipidaemia are considered in order to depict the difference in clinical practice when recommending start of treatment . We label Wortmannin early stage 3 CKD and advanced stage 3 CKD according to this criterion. Among stage 3 CKD patients, the probability of falling into advanced stage 3 CKD by either eGFR <50 ml/min/1.73 m2 or having comorbidity is 83.5%, calculated from the Japan Tokutei-Kenshin CKD Cohort 2008. Each value is shown in Table 1. All participants follow the Markov model after
their completion of detailed examination. Markov model The Markov model consists of five health states: (1) screened and/or examined, (2) ESRD, (3) heart attack, (4) stroke and (5) death. Transitions between these AZD0156 states are indicated by arrows. Although individuals follow various courses other than these five health states and indicated transitions, we model in this way based on available data and literature. We set the span of staying in each state of the Markov model at 1 year. Annual transition probabilities from (1) screened and/or examined to (2) ESRD with no treatment by the initial renal function stratum are calculated from our database of screened LY2835219 cohort in Okinawa Prefecture  for this study, since there is no operational predictive model for progression of CKD to
ESRD such as Tangri et al.  in Japan. Each value is shown in Table 1. Reductions of these transition probabilities brought about by treatment of CKD are set at 42.1% based on Omae et al. , who investigated the effectiveness of about angiotensin-converting enzyme inhibitor in improving renal prognosis. This is a unique Japanese evidence of treatment effectiveness evaluating progression to ESRD which can be compared with our Okinawa cohort . The subsequent transition probabilities to (5) death are calculated from the life expectancy of dialysis starters according to a complete count report of Japanese patients on dialysis  by sex and age. Each value is shown in Table 1. Transition probabilities from (1) screened and/or examined to (3) heart attack with no treatment are adopted from an epidemiological study in Okinawa by Kimura et al.  by initial dipstick test result, age and sex. Each value is shown in Table 1. Reductions of these transition probabilities brought about by treatment of CKD are set at 71.0% based on the Hisayama study by Arima et al. . The subsequent transition probabilities to (5) death are adopted from Kimura et al.  by age and sex for the first year, and from Fukiyama et al.