An Overview of Regular Dialysis Treatment in Japan (As of 31 December 2013)

Abstract

A nationwide survey of 4325 dialysis facilities was conducted at the end of 2013, among which 4268 (98.7%) responded. The number of new dialysis patients was 38,095 in 2013. Since 2008, the number of new dialysis patients has remained almost the same without any marked increase or decrease. The number of dialysis patients who died in 2013 was 30,751. The dialysis patient population has been growing every year in Japan; it was 314,438 at the end of 2013. The number of dialysis patients per million at the end of 2013 was 2470. The crude death rate of dialysis patients in 2013 was 9.8%. The mean age of new dialysis patients was 68.7 years and the mean age of the entire dialysis patient population was 67.2 years. The most common primary cause of renal failure among new dialysis patients was diabetic nephropathy (43.8%). The actual number of new dialysis patients with diabetic nephropathy has almost been unchanged for the last few years. Diabetic nephropathy was also the most common primary disease among the entire dialysis patient population (37.6%), followed by chronic glomerulonephritis (32.4%). The percentage of dialysis patients with diabetic nephropathy has been increasing continuously, whereas the percentage of dialysis patients with chronic glomerulonephritis has been decreasing. The number of patients who underwent hemodiafiltration (HDF) at the end of 2013 was 31,371, a marked increase from that in 2012. This number is more than twice that at the end of 2011 and approximately 1.5 times the number at the end of 2012. In particular, the number of patients who underwent online HDF increased approximately fivefold over the last 2 years. Among 151,426 dialysis patients with primary causes of renal failure other than diabetic nephropathy, 10.8% had a history of diabetes. Among those with a history of diabetes, 26.8% used glycoalbumin as an indicator of blood glucose level; and 33.0 and 27.6% were administered insulin and dipeptidyl peptidase (DPP)-4 inhibitor, respectively, as a medication of diabetes. The facility survey showed that 9392 patients underwent peritoneal dialysis (PD). The patient survey revealed that 1920 of these PD patients also underwent another dialysis method using extracorporeal circulation, such as hemodialysis (HD) or HDF. The number of patients who underwent HD at home at the end of 2013 was 461, a marked increase from that at the end of 2012 (393).

High-Performance Membrane Dialyzers and Mortality in Hemodialysis Patients: A 2-Year Cohort Study from the Annual Survey of the Japanese Renal Data Registry

“…In Japan, kidney transplantation has been performed in a restricted number of patients. Thus, the number of HD patients on long-term dialysis has been increasing significantly every year; there were nearly 314,180 patients at the end of 2013, and 4.2% of them had been on dialysis for over 25 years [23]. In the present study, elderly patients and those with longer dialysis durations were included.…”

Influence of Hemofiltration on Intradialytic Plasma Volume Decrease

“…We could not achieve optimal effectiveness of convective transport in post-ol-HDF [6]; the blood-flow rates generally used in our country are lower than those recommended by the relevant European and American societies [1, 2]. In contrast, we could achieve optimal effectiveness even with low blood-flow rates in pre-ol-HDF; the estimated effective convective rates were > 30% of blood-flow even with low blood-flow rates.…”

“…Priming and washback procedures were performed using dialysate. For pre-ol-HDF and post-ol-HDF, substitution fluid was replaced at constant rates of 10 and 2.5 L/h, respectively, which are generally used in Japan [2]. This study was approved by the hospital ethics committee and registered on the UMIN Clinical Trials Registry (UMIN000028422).…”

“…Maintenance hemodialysis for end-stage renal disease is generally performed intermittently [1, 2]. During each dialysis session, body weight (BW) gain between dialysis sessions is removed by ultrafiltration.…”

Risks and Benefits of Sodium Polystyrene Sulfonate for Hyperkalemia in Patients on Maintenance Hemodialysis

“…An overview of regular dialysis treatment in Japan found that, in 2013, of all deaths in Japanese patients receiving hemodialysis, 775 (2.6%) were attributable to hyperkalemia or sudden death [1]. In the past 20 years, the rate of death due to hyperkalemia or sudden death was constant at 4.3 ± 0.8%.…”