nakai shigeru

The prevalence and incidence of end-stage kidney disease (ESKD) have continued to increase worldwide. Japan was known as having the highest prevalence of ESKD in the world; however, Taiwan took this place in 2001, with the USA still in third position. However, the prevalence data from Japan and Taiwan consisted of dialysis patients only. The prevalence and incidence of Kidney Transplantation (KT) in Japan were quite low, and the number of KT patients among those with ESKD was regarded as negligibly small. However, the number of KT recipients has increased recently. Furthermore, there are no reports about nationwide surveys on the prevalence and incidence of predialysis chronic kidney failure patients in Japan. This review describes our recent study on the estimated number of chronic kidney disease (CKD) stage G5 patients and the number of ESKD patients living in Japan, obtained via the cooperation of five related medical societies. From the results, as of Dec 31, 2007, 275,242 patients had received dialysis therapy and 10,013 patients had a functional transplanted kidney, and as of Dec 31, 2008, 286,406 patients had received dialysis therapy and 11,157 patients had a functional transplanted kidney. Consequently, there were 285,255 patients with CKD who reached ESKD and were living in Japan in 2008 and 297,563 in 2009. We also estimated that there were 67,000 predialysis CKD stage G5 patients in 2009, 37,365 patients introduced to dialysis therapy, and 101 patients who received pre-emptive renal transplantation in this year. In total, there were 37,466 patients who newly required renal replacement therapy (RRT) in 2009. Not only the average ages, but also the primary renal diseases of the new ESKD patients in each RRT modality were different.

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).

Background/Aims: This study aims to identify current risk factors for developing dialysis-related amyloidosis using carpal tunnel syndrome (CTS) as proxy for general amyloidosis. Methods: The cohort consisted of 166,237 patients on dialysis (mean age 66.1 +/- 12.4 years; mean dialysis vintage 7.2 +/- 6.4 years) who could be followed for a year between 2010 and 2011. Of these, 2,157(1.30%) needed first-time CTS surgery during the study period. Odds ratios (ORs) for CTS were calculated at a 95% confidence interval (95% Cl) after adjusting for age, gender, primary kidney disease, history of smoking, history of hypertension vintage, dialysis modality, use of high-flux membrane, body mass index, serum albumin, Kt/V, normalized protein catabolic rate, C-reactive protein, pretreatment beta(2)-microglobulin (beta(2)MG), and beta(2)MG clearance. Results: Adjusted ORs of first-time CTS for vintages 10-15, 15-20, 20-25 (referent), 25-30, and >30 years were, respectively, 0.18 (0.12-0.26), 0.43 (0.31-0.62), 1.00, 2.37 (1.64-3.40), and 3.87(2.52-5.93). Adjusted ORs for ages 40-50, 50-60 (referent), 60-70, 70-80, and >80 were 0.53 (0.30-0.94), 1.00, 1.89 (1.41-2.52), 1.52 (1.08-2.14), and 1.04 (0.60-1.80). Female gender, low serum albumin, and diabetic nephropathy were also associated with CTS. Pretreatment serum beta(2)MG and beta(2)MG clearance <80% were not significant, although beta(2)MG clearance >80% was negatively associated with CTS [OR 0.34 (0.13-0.90)]. Conclusion: ORs of first-time CTS almost doubled with every 5-year increase in dialysis vintage. ORs of CTS were highest for patients aged 60-70. Other factors associated with CTS were gender, serum albumin, and diabetic nephropathy beta(2)MG clearance >80% may decrease the incidence of CTS. (C) 2014 S. Karger AG, Basel

A nationwide statistical survey of 4255 dialysis facilities was conducted at the end of 2011. Responses were submitted by 4213 facilities (99.0%). The number of new patients started on dialysis was 38613 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 30743 in 2011, which exceeded 30000 for the first time. The number of patients undergoing dialysis has also been increasing every year; it was 304856 at the end of 2011, which exceeded 300000 for the first time. The number of dialysis patients per million at the end of 2011 was 2385.4. 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 results on items associated with the Great East Japan Earthquake were reported separately from this report. The mean uric acid levels of the male and female patients were 7.30 and 7.19mg/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 9642 and the number of patients who did not undergo PD despite having a peritoneal dialysis catheter was 369. A basic summary of the results on the survey items associated with PD is included in this report and the details were reported separately.

Amyloid beta proteins (Aβ) in the brain are the main cause of Alzheimer's disease. Peripheral administration of Aβ-binding substances, which may act as a sink for Aβ from the brain, has been reported to reduce brain Aβ. We previously found C16-cellulose beads had high Aβ-removal activity in vitro. In this study, we investigated the optimum surface properties of adsorbents for removal of Aβ in vitro and in humans. Batch analysis was performed with porous cellulose beads or silica beads with or without 2-22 methylene groups. Aβ-removal activity of C16-cellulose beads increased with increasing alkyl chain length. In contrast, with cellulose the amount of Aβ removed by the silica beads decreased with increasing alkyl chain length. Cellulose beads with 16 or 22 methylene groups were best (over 99 % removal) among all the beads tested (p ≤ 0.01). The adsorbent surfaces were analyzed by near-infrared spectroscopy, which revealed that the optimum beads had a sufficiently hydrophobic surface with an appropriate amount of adsorbed water accessible on the surface. Aβ removal efficiency by C16-cellulose beads was investigated for 5 renal failure patients on hemodialysis, resulting in 51.1 ± 6.6 % for Aβ1-40 and 43.8 ± 4.5 % for Aβ1-42 (p ≤ 0.01). In conclusion, cellulose beads with 16 or 22 methylene groups and an appropriate amount of adsorbed water were the optimum Aβ adsorbents. The device with C16-cellulose beads had high Aβ removal activity in humans. These adsorbents might be useful for Alzheimer's disease therapy. © 2012 The Japanese Society for Artificial Organs.

To clarify the therapeutic impact of tonsillectomy and combined therapies of tonsillectomy plus steroid on the long-term prognosis of immunoglobulin A nephropathy (IgAN). A retrospective study was conducted on 208 patients with IgAN between 1986 and 2009. According to the strategies for treatments, patients were divided into four groups: tonsillectomy and steroid pulse (TSP, n = 47), tonsillectomy and oral steroid (TOS, n = 33), tonsillectomy alone (T, n = 56), and N group (no particular therapy, n = 72). Multivariate analysis based on the Cox's regression model was used to assess the relative risk of reaching the outcome of doubling creatinine based on the influence of baseline prognostic factors. The mean observation periods were 53.8 months in the TSP group, 122.0 months in the TOS group, 102.9 months in the T group, and 84.6 months in the N group. During an observation period, serum creatinine levels doubled as follows: one in the TSP group (2.1 %), two in the TOS group (6.1 %), five in the T group (8.9 %), histological severity, and 22 in the N group (30.6 %). The Cox's regression proportional hazard model showed that gender, age, histological activity, dialysis induction risk and therapy were associated with doubling creatinine levels. Hazard ratios (95 % CI) and (P value) in T, TOS, and TSP groups versus N were 0.314 (0.11-0.93, P = 0.037), 0.213 (0.04-1.10, P = 0.065), and 0.032 (0.00-0.28, P = 0.002), respectively. A combination therapy of tonsillectomy and steroid pulse had the most significant therapeutic impact compared to other therapies.

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.

The pathological changes of Alzheimer's disease include the deposition of amyloid beta protein (A beta) as senile plaques in the brain. We hypothesized that the rapid removal of A beta s from the blood may act as a peripheral A beta drainage sink from the brain. In this study, the plasma A beta concentrations and the cognitive functions were investigated for in 57 patients on hemodailysis (69.4 +/- A 3.8 years), 26 renal-failure patients without hemodialysis (66.6 +/- 14.7 years), and 17 age-matched healthy controls (66.6 +/- 4.1 years). The concentrations of plasma A beta s increased along with the decline of renal functions. Moreover, the renal-failure patients without hemodialysis and with poorer renal functions showed lower cognitive functions. The plasma concentrations of A beta(1-42) correlated with serum creatinine (P < 0.001) and Mini-Mental-State Examination scores (P = 0.017). The dialyzers effectively removed A beta s in the blood during hemodialysis sessions. The plasma A beta concentrations showed steady or slightly decreasing along with duration of hemodialysis. The total amount of A beta s removed during a hemodialysis session was calculated to be comparable to the A beta s dissolved in the blood and the cerebrospinal fluid. The MMSE scores of the hemodialysis patients showed no clear decrease in longer hemodialysis duration. Therefore, the therapeutic approach for Alzheimer's disease by removing A beta s from the blood is worthy of further investigation, including whether or not A beta s in the brain decrease.

A nationwide statistical survey of 4226 dialysis facilities was conducted at the end of 2010, and 4166 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 7591 (2.6%) compared with that at the end of 2009. The number of dialysis patients per million at the end of 2010 was 2329.1. 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 durations of 2024 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.

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.

Home hemodialysis (HHD) started in Japan in 1969. It has been done in the largest number of patients with the purpose of better social reintegration, followed by patients for whom commuting to a hospital is geographically difficult. In a subanalysis of the JSDT patient registry, the survival rate at 9 years for male patients excluding those with diabetes was significantly better in HHD patients than in facility dialysis patients. This result was thought to indicate that HHD was superior treatment both medically and socially, but it has not increased greatly because of conditions that impede the implementation of HHD, such as finding a caregiver and the burden on the caregiver, as well as the burden of light, heat, and water costs. However, long-duration dialysis and frequent dialysis are done even in general dialysis treatment, and the number of HHD patients has increased recently because of some improvement in health insurance payments for HHD in 1998. The spread of HHD is essential also in the broad implementation of diversifying HD modalities, and maintaining an accurate registry of HHD patients, analyzing factors that affect survival rates with each modality, clarifying conditions for adequacy of dialysis, and clarifying which treatments are superior are important future issues for dialysis treatment. Copyright © 2012 S. Karger AG, Basel.

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 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.

Previous studies have suggested that early initiation of dialysis therapy was not superior in terms of patient survival. In this study, we analyzed the effects of renal function at the start of renal replacement therapy (RRT), duration of nephrology care, and comorbidity on 12-month survival of end-stage renal disease (ESRD) patients. The subjects in this study were 9695 new ESRD patients who started RRT in 2007. The average age of the subjects was 67.5 years, 64.1% of the subjects were male, and 42.9% had diabetes. During the 12-month period after the start of RRT, 1546 patients died, and 35 patients received renal transplantation. Average estimated glomerular filtration rate (eGFR) at the initiation of dialysis was 6.52 +/- 4.20 mL/min/1.73 m2. By unadjusted logistic analysis, one-year Odds Ratio (OR) of mortality in patients with eGFR more than 46 mL/min/1.73 m2 was increased with increased eGFR at dialysis initiation, but the OR was identical among the groups with eGFR less than 4 mL/min/1.73 m2. After adjustment for age, gender, underlying renal diseases, and other clinical characteristics at dialysis initiation, OR was identical among the groups with eGFR less than 8 mL/min/1.73 m2. Furthermore, an OR increment was observed in eGFR less than 4 mL/min/1.73 m2 group. In terms of the duration of nephrology care before dialysis initiation, 6 months or longer of nephrology care significantly decreased the OR of mortality after adjustment of covariance. Not only patients with sufficient residual renal function at the initiation of dialysis, but also patients with very low eGFR at the initiation of dialysis showed poor survival.

A nationwide statistical survey of 4196 dialysis facilities was conducted at the end of 2009, and 4133 facilities (98.5%) responded. The number of patients undergoing dialysis at the end of 2009 was determined to be 290 661, an increase of 7240 patients (2.6%) compared with that of 2008. The number of dialysis patients per million at the end of 2009 was 2279.5. 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 satisfied the microbiological quality standard for dialysis fluids for the Japanese Society for Dialysis Therapy (JSDT), with an endotoxin concentration of less than 0.05 EU/mL in the dialysis fluid. Similarly, 98.2% of the facilities surveyed satisfied another standard of the society of a bacterial count of less than 100 cfu/mL in the dialysis fluid. The facility survey indicated that the number of patients who were treated by blood purification by both peritoneal dialysis and extracorporeal circulation, such as hemodialysis, was 1720. 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 parathyroid hormone concentration. According to the questionnaire, 9.8% of the patients were considered to have a complication of dementia.

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.

Background: Patient responsiveness to erythropoiesis-stimulating agents (ESAs), notoriously difficult to measure, has attracted attention for its association with mortality. We defined categories of ESA responsiveness and attempted to clarify their association with mortality. Study Design: Cohort study. Setting & Participants: Data from Japan's dialysis registry (2005-2006), including 95,460 adult hemodialysis patients who received ESAs. Predictor: We defined 6 categories of ESA responsiveness based on a combination of ESA dosage (low [&lt;6,000 U/wk] or high [&gt;= 6,000 U/wk]) and hemoglobin level (low [&lt;10 g/dL], medium [10-11.9 g/dL], or high [&gt;= 12 g/dL]), with medium hemoglobin level and low-dose ESA therapy as the reference category. Outcomes: All-cause and cardiovascular mortality during 1-year follow-up. Measurements: HRs were estimated using a Cox model for the association between responsiveness categories and mortality, adjusting for potential confounders such as age, sex, postdialysis weight, dialysis duration, comorbid conditions, serum albumin level, and transferrin saturation. Results: Median ESA dosage (4,500-5,999 U/wk) was used as a cutoff point, and mean hemoglobin level was 10.1 g/dL in our cohort. Of 95,460 patients during follow-up, 7,205 (7.5%) died of all causes, including 5,586 (5.9%) cardiovascular deaths. Low hemoglobin levels and high-dose ESA therapy were both associated with all-cause mortality (adjusted HRs, 1.18 [95% CI, 1.09-1.27] for low hemoglobin level with low-dose ESA and 1.44 [95% CI, 1.34-1.55] for medium hemoglobin level with high-dose ESA). Adjusted HRs for high-dose ESA with low hemoglobin level (hyporesponsiveness) were 1.94 (95% CI, 1.82-2.07) for all-cause and 2.02 (95% CI, 1.88-2.17) for cardiovascular mortality. We also noted the interaction between ESA dosage and hemoglobin level on all-cause mortality (likelihood ratio test, P = 0.002). Limitations: Potential residual confounding from unmeasured factors and single measurement of predictors. Conclusions: Mortality can be affected by ESA responsiveness, which may include independent and interactive effects of ESA dose and hemoglobin level. Responsiveness category has prognostic importance and clinical relevance in anemia management. Am J Kidney Dis. 59(1):108-116. (C) 2011 by the National Kidney Foundation, Inc.

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.

Background/Aims: Rapid removal of plasma amyloid-beta (A beta) by blood purification may serve as a peripheral A beta sink from the brain for Alzheimer&apos;s disease therapy. We investigated the reduction of plasma A beta during hemodialysis and cognitive states. Methods: A beta concentrations and Mini-Mental State Examinations (MMSE) were investigated in 37 hemodialysis patients (68.9 +/- 4.1 years). Results: The dialyzers effectively removed A beta(1-40) and A beta(1-42), 63.9 +/- 14.4 and 51.6 +/- 17.0% at 4 h dialysis, resulting in the reduction of A beta s in whole-body circulation by 51.1 +/- 8.9 and 32.7 +/- 12.0%, respectively. Although the plasma A beta s before dialysis (750.8 +/- 171.3 pg/ml for A beta(1-40)) were higher than those reported for Alzheimer&apos;s disease patients, the cognitive states of hemodialysis patients were relatively normal, especially of longer dialysis vintages. Conclusions: Dialyzers effectively reduced A beta s in whole-body circulation. Repeated rapid decrease of plasma A beta s might maintain cognitive state. Copyright (C) 2011 S. Karger AG, Basel

A nationwide statistical survey of 4124 dialysis facilities was conducted at the end of 2008 and 4081 facilities (99.0%) responded. The number of patients undergoing dialysis at the end of 2008 was determined to be 283 421, an increase of 8179 patients (3.0%) compared with that at the end of 2007. The number of dialysis patients per million at the end of 2008 was 2220. The crude death rate of dialysis patients from the end of 2007 to the end of 2008 was 9.8%. The mean age of the new patients begun on dialysis was 67.2 years and the mean age of the entire dialysis patient population was 65.3 years. For the primary diseases of the new patients begun on dialysis, the percentages of patients with diabetic nephropathy and chronic glomerulonephritis were 43.3% and 22.8%, respectively. Among the facilities that measured bacterial count in the dialysate solution in 2008, 52.0% of facilities ensured that a minimum dialysate solution volume of 10 mL was sampled. Among the patients treated by facility dialysis, 95.4% of patients were treated three times a week, and the average time required for one treatment was 3.92 +/- 0.53 (SD) h. The average amounts of blood flow and dialysate solution flow were 197 +/- 31 and 487 +/- 33 mL/min, respectively. The number of patients using a polysulfone membrane dialyzer was the largest (50.7%) and the average membrane area was 1.63 +/- 0.35 m2. According to the classification of dialyzers by function, the number of patients using a type IV dialyzer was the largest (80.3%). The average concentrations of each electrolyte before treatment in patients treated with blood purification by extracorporeal circulation were 138.8 +/- 3.3 mEq/L for serum sodium, 4.96 +/- 0.81 mEq/L for serum potassium, 102.1 +/- 3.1 mEq/L for serum chloride, and 20.7 +/- 3.0 mEq/L for HCO(3)-; the average serum pH was 7.35 +/- 0.05. Regarding the type of vascular access in patients treated by facility dialysis, in 89.7% of patients an arteriovenous fistula was used and in 7.1% an arteriovenous graft was used. The percentage of hepatitis C virus (HCV)-positive patients who were HCV-negative in 2007 was 1.04%; the percentage is particularly high in patients with a period of dialysis of 20 years or longer. The risk of becoming HCV-positive was high in patients with low serum creatinine, serum albumin, and serum total cholesterol levels, and/or a low body mass index before beginning dialysis.

Aggressive removal of circulating free light chains (FLC) by blood purification accompanied by chemotherapy is a promising approach for the treatment of acute renal failure due to myeloma cast nephropathy. Plasma exchange has been performed to remove serum FLC; in order to examine an alternative strategy we performed hemodiafiltration using protein-leaking dialyzers for the treatment of dialysis-dependent acute renal failure due to myeloma cast nephropathy. In the first case with kappa-light chain cast nephropathy, the pre-treatment serum creatinine was 9.65 mg/dL, and the serum kappa-FLC was 27 100 mg/L. Plasma exchange or hemodiafiltration was performed from Monday to Friday during the first several weeks. Chemotherapy was started with high-dose dexamethasone and then switched to bortezomib plus dexamethasone. The mean removal rates of kappa-FLC were 45.8% (one plasma volume) and 66.9% (one-and-a-half plasma volumes) by plasma exchange. The removal rates of kappa-FLC by hemodiafiltration (66.9%, FB210UH beta; 71.6%, PES210D alpha; 75.2%, FXS220) were comparable to those by plasma exchange. In the second case with lambda-light chain cast nephropathy, the pre-treatment serum creatinine was 4.14 mg/dL, and the serum lambda-FLC was 4140 mg/L. The mean removal rates of lambda-FLC were 60.2% (FXS140) and 64.2% (FB210UH beta) by hemodiafiltration. Both cases became dialysis-independent. The combination of an intense blood purification regimen and bortezomib plus dexamethasone therapy appears to be an efficient approach to renal recovery. Hemodiafiltration using protein-leaking dialyzers could become an alternative to plasma exchange as a method of removing FLC.

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.

The Japanese Society for Dialysis Therapy (JSDT) guideline committee, chaired by Dr Y. Tsubakihara, presents the Japanese guidelines entitled "Guidelines for Renal Anemia in Chronic Kidney Disease." These guidelines replace the "2004 JSDT Guidelines for Renal Anemia in Chronic Hemodialysis Patients," and contain new, additional guidelines for peritoneal dialysis (PD), non-dialysis (ND), and pediatric chronic kidney disease (CKD) patients.

The accumulation of amyloid beta (A beta) protein in the brain reflects the cognitive impairment noted in Alzheimer&apos;s disease. Recent studies have shown that brain A beta disappeared and cognitive improvement occurred as a result of passive or active A beta immunization. Peripheral administration of nonimmunization substances, such as GM1 ganglioside, also reduced brain A beta. Therefore, we hypothesized that the rapid removal of A beta from the blood by an extracorporeal system may act as a peripheral A beta sink from the brain. In the present study, we investigated the A beta removal activity of medical materials as a first step toward the design of an A beta removal system. First, the removal activities of six materials were studied for A beta(1-40) and A beta(1-42) by batch analysis in albumin solution or in human plasma for 1-16 h. Two of the six materials reduced the A beta concentrations by 90-99% within 1 h. Next, the two effective materials, hexadecyl-alkylated cellulose particles (HDC) and charcoal, were analyzed in a continuous single-pass system with minicolumns. Both materials showed around 81-90% removal activity for more than 2 h, which corresponded to over 4 l of plasma treatment in humans. In a human extracorporeal system, HDC also removed both A beta(1-40) and A beta(1-42) from whole blood circulation. In conclusion, biomedical materials were found that could remove A beta(1-40) and A beta(1-42) effectively in an extracorporeal system. It is now conceivable that further studies can be undertaken to reduce A beta concentrations in the brain to improve cognitive function.