nakai shigeru

In 2009, we started the peritoneal dialysis (PD) registry with the cooperation of the Japanese Society for Peritoneal Dialysis as part of the annual nationwide survey conducted at the end of each year by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy. In this study, we examined the current status of PD patients on the basis of the 2012 survey results. The subjects are PD patients who lived in Japan and participated in the nationwide survey conducted at the end of 2012. Descriptive analysis was performed mainly focusing on the current status of the combined use of PD and another method such as hemodialysis (HD) or hemodiafiltration (HDF), the method of dialysate exchange, the use of an automated peritoneal dialysis (APD) machine, and the incidences of peritonitis and catheter exit-site infection. From the results of the facility survey in 2012, the number of PD patients was 9,514, a decrease of 128 from that in 2011. The percentage of PD patients with respect to all the dialysis patients was 3.1%, a decrease of 0.1%. Among the PD patients, 347 did not undergo PD despite having a peritoneal lavage catheter, 175 were started on PD in 2012 but introduced to other blood purification methods in 2012, and 1,932 underwent both PD and another method such as HD or HDF (PD+HD combination therapy). The percentage of patients who underwent PD+HD combination therapy increased with the number of years on PD (PD period): less than 1 year, 4.8%; 1-2 years, 9.2% ; 2-4 years, 16.3% ; 4-8 years, 32.0% ; and 8 years or longer, 47.5%. The percentage of PD patients for which the dialysate was completely manually exchanged was 29.8%, whereas the percentages of PD patients who used a bag-exchange device based on ultraviolet-light irradiation and thermal sterile joint systems were 54.7 and 13.9%, respectively. The percentage of PD patients who used an APD machine was 43.4% with respect to the PD patients with a PD period of less than one year ; this decreased with increasing PD period beyond two years. The mean incidences of peritonitis and catheter-exit-site infection were 0.22 and 0.36 per patient per year, respectively.

A nationwide statistical survey of 4,279 dialysis facilities was conducted at the end of 2012, among which 4,238 responded (99.0%). The number of new dialysis patients was 38,055 in 2012. 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 2012 was 30,710, a slight decrease from that in 2011 (30,743). The dialysis patient population has been growing every year in Japan ; it was 310,007 at the end of 2012, which exceeded 310,000 for the first time. The number of dialysis patients per million at the end of 2012 was 2,431.2. The crude death rate of dialysis patients in 2012 was 10.0%, a slight decrease from that in 2011 (10.2%). The mean age of new dialysis patients was 68.5 years and the mean age of the entire dialysis patient population was 66.9 years. The most common primary cause of renal failure among new dialysis patients was diabetic nephropathy (44.2%). The actual number of new dialysis patients with diabetic nephropathy has been approximately 16,000 for the last few years. Diabetic nephropathy was also the most common primary disease among the entire dialysis patient population (37.1%), followed by chronic glomerulonephritis (33.6%). The percentage of dialysis patients with diabetic nephropathy has been continuously increasing, whereas not only the percentage but also the actual number of dialysis patients with chronic glomerulonephritis has decreased. The number of patients who underwent hemodiafiltration (HDF) at the end of 2012 was 21,725, a marked increase from that in 2011 (14,115). In particular, the number of patients who underwent online HDF increased threefold from 4,890 in 2011 to 14,069 in 2012. From the results of the facility survey, the number of patients who underwent peritoneal dialysis (PD) was 9,514 and that of patients who did not undergo PD despite having a PD catheter in the abdominal cavity was 347. From the results of the patient survey, among the PD patients, 1,932 also underwent another dialysis method using extracorporeal circulation, such as hemodialysis (HD) and HDF. The number of patients who underwent HD at home in 2012 was 393, a marked increase from that in 2011 (327).

A nationwide statistical survey of 4,255 dialysis facilities was conducted at the end of 2011. Responses were submitted by 4,213 facilities (99.0%). The number of new patients started on dialysis was 38,613 in 2011. Although the number of new patients decreased in 2009 and 2010, it increased in 2011. The number of patients who died each year has been increasing; it was 30,743 in 2011, which exceeded 30,000 for the first time. The number of patients undergoing dialysis has also been increasing every year; it was 304,856 at the end of 2011, which exceeded 300,000 for the first time. The number of dialysis patients per million at the end of 2011 was 2,385.4. The crude death rate of dialysis patients in 2011 was 10.2%, which exceeded 10% for the first time in the last 20 years. The mean age of new dialysis patients was 67.84 years and the mean age of the entire dialysis patient population was 66.55 years. The most common primary cause of renal failure among new dialysis patients was diabetic nephropathy (44.3%). Diabetic nephropathy was also the most common primary disease among the entire dialysis patient population (36.7%), exceeding chronic glomerulonephritis (34.8%) which had been the highest until last year. The survey included questions related to the Great East Japan Earthquake, which occurred on 11 March 2011. The number of dialysis facilities that were affected by the earthquake with a seismic intensity of at least 6 was high in the Tohoku region. The number of facilities affected by a seismic intensity between 5 and 6 was high in the Kanto region. The number of dialysis facilities that could not continue providing medical services owing to the earthquake was 315. As a result, a total of 10,906 patients were transferred to other dialysis facilities after the earthquake. The mean uric acid levels of the male and female patients were 7.30 and 7.19 mg/dL, respectively. Certain drugs for hyperuricemia were prescribed for approximately 17% of patients. From the results of the facility survey, the number of patients who underwent peritoneal dialysis (PD) was 9,642 and the number of patients who did not undergo PD despite having a peritoneal dialysis catheter was 369.

We estimated the future dialysis population in Japan based on the registry data of the Japanese Society for Dialysis Therapy (JRDR) during 2001 to 2010. We used the prevalence of dialysis patients in the annual JRDR from 2001 to 2010, and calculated the changes in number of dialysis patients from 2002 to 2010 (9 years). The annual rate of increase was plotted by linear model using the prevalent number in each year. (y=450.372044-0.222751x, R-square=0.7227, p=0.0037). Based on this formula, we estimated annual rate of increase and prevalence in the following years. Results were that the prevalence would reach to its maximum prevalence of 348,873 in 2021 (90% confidence interval: 302,868 to 401,119), then start to decline gradually.

A retrospective observational study was conducted to determine the relationship between the treatment time (TT)/blood flow rate (Qb)/dialysis dose (Kt urea) and patient mortality using data from the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). The 1-year mortality (up to the end of 2003) and 5-year mortality (up to the end of 2007) risks of thrice-weekly HD patients as of the end of 2002 were assessed by performing a logistic regression analysis of HD prescription and dose data, using a cause of death other than accident or suicide as the endpoint. The patients were stratified by sex, post-dialysis body weight (PDBW), predialysis serum albumin (Alb), creatinine generation rate corrected by sex and age (%CGR), and normalized protein catabolic rate (nPCR). The results for patients on HD for 5 or more years were as follows: When a TT of ≥240min and <270min was regarded as the reference, the mortality risk was higher in the group of patients with a shorter TT and lower in patients with a longer TT regardless of subgroups. When a Qb of ≥200mL/min and <220mL/min was regarded as the reference, the mortality risk was higher in the patients with a lower Qb, and lower in the group of patients with a higher Qb, except female patients and patients aged ≥75, PDBW <40kg, Alb <3.0g/dL, %CGR <80%, and nPCR <0.7g/kg/day. When a Kt urea of ≥38.8L and <42.7L was used as the reference, the group of patients with a Kt urea smaller than this had an increased mortality risk, and patients with a larger Kt urea had a decreased mortality risk, except those with Alb <3.0g/dL, %CGR <80%, and nPCR<0.7g/kg/day. The results for patients on HD for less than 5 years were similar. These results suggest that the life prognosis of thrice-weekly HD patients may be improved by increasing the dialysis dose through a longer TT and increased Qb, except for malnourished patients.

A nationwide statistical survey of 4,226 dialysis facilities was conducted at the end of 2010, and 4,166 facilities (98.6%) responded. The number of new patients introduced into dialysis was 37,512 in 2010. This number has decreased for two consecutive years since it peaked in 2008. The number of patients who died in 2010 was 28,882, which has been increasing every year. The number of patients undergoing dialysis at the end of 2010 was 298,252, which is an increase of 7,591 (2.6%) compared with that at the end of 2009. The number of dialysis patients per million at the end of 2010 was 2,329.1. The crude death rate of dialysis patients in 2010 was 9.8%, and has been gradually increasing. The mean age of the new patients introduced into dialysis was 67.8 years and the mean age of the entire dialysis patient population was 66.2 years. Regarding the primary disease of the new patients introduced into dialysis, the percentage of patients with diabetic nephropathy was 43.6%, which is a slight decrease from that in the previous year (44.5%). Patients with diabetic nephropathy as the primary disease accounted for 35.9% of the entire dialysis patient population, which approaches the percentage of patients with chronic glomerulonephritis as the primary disease (36.2%). The percentage of patients who had undergone carpal tunnel release surgery (CTx) was 4.3%, which is a slight decrease from that at the end of 1999 (5.5%). The decrease in the percentage of patients who had undergone CTx was significant among the patients with dialysis periods of 20-24 years (1999, 48.0%; 2010, 23.2%). A total weekly Kt/V attributable to peritoneal dialysis and their residual functional kidney was 1.7 or higher for 59.4% of patients who underwent peritoneal dialysis.

A nationwide statistical survey of 4,196 dialysis facilities was conducted at the end of 2009, and 4,133 facilities (98.5%) responded. The number of patients undergoing dialysis at the end of 2009 was determined to be 290,661, an increase of 7,240 patients (2.6%) compared to that of 2008. The number of dialysis patients per million at the end of 2009 was 2,279.5. The crude death rate of dialysis patients from the end of 2008 to the end of 2009 was 9.6%. The mean age of the new patients introduced into dialysis was 67.3 years old and the mean age of the entire dialysis patient population was 65.8 years old. Primary diseases such as diabetic nephropathy and chronic glomerulonephritis for new dialysis patients, showed a percentage of 44.5% and 21.9%, respectively. Based on the facilities surveyed, 84.2% of the facilities that responded to the questionnaire were satisfied the dialysate solution quality control standard for the Japanese Society for Dialysis Therapy (JSDT), i.e., with an endotoxin concentration of less than 0.05EU/mL in the dialysate solution. Similarly, 98.2% of the facilities surveyed were satisfied with another standard of the society of a bacterial count of less than 100 cfu/mL in the dialysate solution. The patients'survey indicated that the number of patients who were treated by blood purification by both peritoneal dialysis and extracorporeal circulation, such as hemofiltration, was 1,569. Among the total number of patients, 24.8% were satisfied with the management target recommended in the treatment guidelines for secondary hyperparathyroidism. These standards are set by the JSDT, based on the three parameters, i.e., serum calcium concentration, serum phosphorus concentration, and serum intact PTH concentration. According to the questionnaire, 9.8% of the patients were considered to have a complication of dementia.

A retrospective observational study was conducted to determine the relationship between the hemodialysis (HD) prescription/dose and patient mortality using data from the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR). The 1-year mortality (up to the end of 2003) and 5-year mortality (up to the end of 2007) risks of thrice-weekly HD patients as of the end of 2002 were assessed by performing a logistic regression analysis of HD prescription and dose data, using a cause of death other than accident or suicide as the endpoint. The standard HD prescription (determined by average values) at the end of 2002 was as follows : dialysis time (DT), 239 min ; blood flow rate (Qb), 192 mL/min ; dialyzer membrane area (DMA), 1.55 m² ; and dialysis fluid flow (Qd), 486 mL/min. On average, the standardized HD dose of urea (Kt/V urea) was 1.32, and the nonexponential HD dose (Kt urea) was 40.7 L. The results of the prognostic analysis showed that when a DT of ≥240 and<270 min was regarded as the reference, the mortality risk was higher in the group of patients with a DT shorter than this, and tended to be lower in the patients with a longer DT. When a Qb of ≥200 and<220 mL/min was regarded as the reference, the mortality risk was higher in patients with a lower Qb and tended to be lower in the group of patients with a higher Qb. The mortality risk was higher in the group of patients with a DMA of<1.2 m², but there was no clear relationship between the mortality risk and DMA values other than 1.2 m². When a Kt/V urea of ≥1.4 and<1.6 or a Kt urea of ≥38.8 and<42.7 L was used as the reference, the group of patients with an HD dose smaller than this showed an increased mortality risk, and patients with a larger HD dose exhibited a decreased mortality risk. These results were favorable in patients receiving HD for 5 years or more at the time of the present study, who were assumed to have no residual renal function. These results suggest that the prognosis of thrice-weekly HD patients may be improved by increasing the HD dose through a longer DT and increased Qb.