An Overview of Regular Dialysis Treatment in Japan (as of 31 December 2004)

Abstract

A statistical survey of 3932 nationwide hemodialysis (hereafter, dialysis) facilities was carried out at the end of 2004, and 3882 facilities (98.73%) responded. The population undergoing dialysis at the end of 2004 was 248 166, an increase of 10 456 patients (4.4%) from that at the end of 2003. The number of dialysis patients per million people was 1943.5. The crude death rate of dialysis patients from the end of 2003 to the end of 2004 was 9.4%. The mean age of patients who underwent dialysis in 2004 was 65.8 years, and that of the total dialysis population was 63.3 years. The percentage distribution of patients who underwent dialysis according to a newly underlying disease showed that 41.3% of patients had diabetic nephropathy and 28.1% had chronic glomerulonephritis. The frequency of calcium carbonate use for dialysis patients was 75.1% and that of sevelamer hydrochloride use was 26.2%. The frequency of sevelamer hydrochloride use does not necessarily have a strong correlation with the dose of calcium carbonate. Patients who received high doses of sevelamer hydrochloride tended to have a low concentration of arterial blood HCO(3-). Approximately 15% of dialysis patients used an intravenous vitamin D preparation, generally maxacalcitol. The longer the patients had been on dialysis, the higher the frequency of use of an intravenous vitamin D preparation. When the concentration of serum intact parathyroid hormone (PTH) was more than 200 pg/mL, the frequency of use of an orally administered vitamin D preparation decreased; but that of intravenous vitamin D preparation increased. The percentage of dialysis patients who received percutaneous ethanol injection therapy (PEIT) was 1.4%. The percentage was more than 50% in the patients who had been on dialysis for more than 10 years. The percentage of patients who received PEIT again was 35.0%. The percentage of patients who had been on hemodialysis for more than 10 years and received PEIT again was more than 50%.

Mortality Predictors after 10 Years of Dialysis

“…The annual crude mortality rate in Japanese HD patients has been Ͻ10% in the past two decades (13). This combined with the growing numbers of patients who have ESRD are started on an HD program every year have resulted in an exponential increase of the HD population nationwide, with more patients having survived longer terms on maintenance therapy.…”

Cardio-Ankle Vascular Index to Screen Cardiovascular Diseases in Patients with End-Stage Renal Diseases

“…Cardiovascular disease is a major cause of death in patients with chronic kidney diseases 2) ; however, concomitant conditions such as bone-joint diseases and/or renal anemia cause patients with chronic kidney diseases to have reduced exercise tolerability, masking the symptoms of cardiovascular diseases. Extensive investigations into the presence of cardiovascular diseases are not allowed for patients with chronic kidney diseases, mainly due to socio-economical problems.…”

Chronic Kidney Disease in Japan from Early Predictions to Current Facts

“…According to the Japanese Society for Dialysis Therapy, the prevalence of patients with treated ESRD on chronic dialysis therapy has been >2,000 per million population since 2005 [4] and it increased to 2,153 per million population at the end of 2007. The incidence of treated ESRD is also increasing despite several strategies, including universal screening and the use of presumably effective drugs [5].…”