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).