protein catabolic rate of less than 0.9g/kg/day or more than 1.5g/kg/day, and a low creatinine generation rate were risk factors in the 6-year mid-term prognosis for hemodialysis patients.
Long-term hemodialysis (HD) patients complaining of shoulder joint pain were treated by HD and by push/pull HDF using high-flux synthetic membranes with large pores (Asahi PAN 20CX2) for 2 weeks. The results showed no significant difference in Kt/Vurea between HD and push/pull HDF. Nevertheless, reduction of the plasma beta 2-microglobulin was greater during push/pull HDF than during HD. These findings can be explained by far more convective flux in push/pull HDF than in HD: nearly 30 L during push/pull HDF vs. 3 L during HD. In the present study, there was no alleviation of the shoulder joint pain during HD treatment, whereas marked relief of the symptom was found during push/pull HDF treatment. Since the two treatment modalities differ simply in their efficiency in removing larger molecular weight substances, the joint pain alleviation effected by push/pull HDF could well be ascribed to elimination of an unknown larger molecular weight substance causing this symptom. However, a considerable amount of beta 2-microglobulin was removed both by HD and push/pull HDF. Therefore, the substance causing the joint pain might be larger than beta 2-microglobulin.
Japan has the highest prevalence of dialysis patients in the world. According to the Annual Report of the Japanese Society for Dialysis Therapy (JSDT; 2002), the total dialysis population was 229 538 (1801.5 patients per million population) at the end of 2002. The annual crude mortality rate has been less than 10%. Survival rates in the incident dialysis patients were 0.874 for 1 year, 0.609 for 5 years, and 0.391 for 10 years. Despite the increased acceptance for dialysis of elderly patients, those with comorbid conditions, and those with diabetes mellitus, the adjusted hazard ratios for death have been improving since 1983. This improvement was obtained by delivering a dialysis dose of Kt/V 1.33 and dialysis sessions of 4 h. Independently of the JSDT registry, there exists a local dialysis registry in Okinawa, the Okinawa Dialysis Study (OKIDS) registry, in which are filed the records of every chronic dialysis patient from the beginning of dialysis therapy in 1971 to the end of 2000. Several outcome studies have been conducted to determine the factors related to survival, using the data in that registry. There are distinct differences in environmental and socioeconomic conditions and lifestyles within a given country, and between countries and ethnic groups, that may affect the survival of dialysis patients. In this article, both the JSDT registry and OKIDS data are reviewed in order to identify factors related to the survival of chronic dialysis patients.
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