Satoshi Ogata

Overview of Regular Dialysis Treatment in Japan (as of 31 December 2008)

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 283u2003421, 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 67.2u2003years and the mean age of the entire dialysis patient population was 65.3u2003years. 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 10u2003mL 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 3.92u2003±u20030.53u2003(SD)u2003h. The average amounts of blood flow and dialysate solution flow were 197u2003±u200331 and 487u2003±u200333u2003mL/min, respectively. The number of patients using a polysulfone membrane dialyzer was the largest (50.7%) and the average membrane area was 1.63u2003±u20030.35u2003m2. According to the classification of dialyzers by function, the number of patients using a typeu2003IV dialyzer was the largest (80.3%). The average concentrations of each electrolyte before treatment in patients treated with blood purification by extracorporeal circulation were 138.8u2003±u20033.3u2003mEq/L for serum sodium, 4.96u2003±u20030.81u2003mEq/L for serum potassium, 102.1u2003±u20033.1u2003mEq/L for serum chloride, and 20.7u2003±u20033.0u2003mEq/L for HCO3‐; the average serum pH was 7.35u2003±u20030.05. 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.

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

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 38u2009095 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 30u2009751. The dialysis patient population has been growing every year in Japan; it was 314u2009438 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 68.7u2009years and the mean age of the entire dialysis patient population was 67.2u2009years. 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 31u2009371, 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 151u2009426 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).

An Overview of Regular Dialysis Treatment in Japan (As of 31 December 2010)

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 37u2003512 in 2010. This number has decreased for two consecutive years since it peaked in 2008. The number of patients who died in 2010 was 28u2003882, which has been increasing every year. The number of patients undergoing dialysis at the end of 2010 was 298u2003252, 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 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.

An Overview of Regular Dialysis Treatment in Japan (as of 31 December 2012)

A nationwide statistical survey of 4279 dialysis facilities was conducted at the end of 2012, among which 4238 responded (99.0%). The number of new dialysis patients was 38u2009055 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 30u2009710; a slight decrease from 2011 (30u2009743). The dialysis patient population has been growing every year in Japan; it was 310u2009007 at the end of 2012, which exceeded 310u2009000 for the first time. The number of dialysis patients per million at the end of 2012 was 2431.2. 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 16u2009000 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 21u2009725, a marked increase from that in 2011 (14u2009115). In particular, the number of patients who underwent on‐line HDF increased threefold from 4890 in 2011 to 14u2009069 in 2012. From the results of the facility survey, the number of patients who underwent peritoneal dialysis (PD) was 9514 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, 1932 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).

An overview of regular dialysis treatment in Japan (as of 31 December 2007).

A nationwide statistical survey of 4098 dialysis facilities was conducted at the end of 2007, and 4052 facilities (98.88%) participated. The number of patients undergoing dialysis at the end of 2007 was determined to be 275u2003242, an increase of 10u2003769 patients (4.1%) compared with that at the end of 2006.The number of dialysis patients per million at the end of 2007 was 2154. The crude death rate of dialysis patients at the end of 2007 from the end of 2006 was 9.4%. The mean age of new patients begun on dialysis was 66.8u2003years and the mean age of the entire dialysis patient population was 64.9u2003years. For the primary diseases of new patients begun on dialysis, the percentages of patients with diabetic nephropathy and chronic glomerulonephritis were 43.4% and 23.8%, respectively. The percentages of facilities that achieved the control standard of endotoxin concentration in the dialysate solution of <0.05u2003EU/mL and those that achieved a bacterial count of <100u2003cfu/mL in the dialysate solution, as specified by the Japanese Society for Dialysis Therapy, were 93.6% and 97.4%, respectively. The percentage of patients positive for the hepatitis C virus antibody among the entire dialysis population significantly decreased from 15.95% at the end of 1999 to 9.83% at the end of 2007. The mean hemoglobin concentration in all the dialysis patients at the end of 2007 was 10.27 (±1.32, SD)u2003g/dL, which has scarcely changed over the last three years. The numbers of male and female patients with a history of hip fracture were 142.9 and 339.0 per 10u2003000 dialysis patients, respectively, showing an extremely high prevalence among female patients. A history of hip fracture correlates with a low body mass index, serum albumin concentration, and a history of diabetes. The serum creatinine level of patients upon introduction to dialysis was 8.34 (±3.55)u2003mg/dL, and the estimated glomerular filtration rate was 5.43 (±3.43)u2003mL/min/1.73u2003m2 for the patients who were newly begun on dialysis in 2007.

Overview of Regular Dialysis Treatment in Japan (as of 31 December 2011)

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 38u2009613 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 30u2009743 in 2011, which exceeded 30u2009000 for the first time. The number of patients undergoing dialysis has also been increasing every year; it was 304u2009856 at the end of 2011, which exceeded 300u2009000 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 7.19u2009mg/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.

Overview of Regular Dialysis Treatment in Japan (as of 31 December 2009)

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 290u2003661, 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 67.3u2003years old and the mean age of the entire dialysis patient population was 65.8u2003years 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 0.05u2003EU/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 100u2003cfu/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.

Annual Dialysis Data Report 2014, JSDT Renal Data Registry (JRDR)

BackgroundThe Japanese Society for Dialysis Therapy (JSDT) has performed a nationwide renal data registry since 1966. The data from the survey have been used for promoting dialysis facilities to improve dialysis quality and developing JSDT guidelines. Here, we summarized the current status of chronic dialysis in Japan as of 31 December 2014.MethodsThe annual survey was conducted targeting for 4367 dialysis facilities by electrically and partially paper-based; among which, 4330 (99.2%) responded. The results shown in this report are all descriptive, and no statistical analyses were conducted.ResultsThe number of the incident dialysis patients was 38,327 and that of the prevalent dialysis patients was 320,448 in 2014. The count of prevalent dialysis patients per million population was 2517. The count of dialysis patients who died in 2014 was 30,707, and the crude mortality rate was 9.6%. The mean age of incident dialysis patients was 69.04xa0years, and the mean age of the prevalent dialysis patients was 67.54xa0years. The most common primary cause on the incident and prevalent dialysis patients was diabetic nephropathy. The patient count on hemodiafiltration (HDF) at the end of 2014 was 43,283; in particular, the number of online HDF patients increased more than 2.5 times over the last 3xa0years. The facility survey showed that 9255 patients were on peritoneal dialysis (PD) in 2014. Among them, 1913 patients were treated by the combination of PD and hemodialysis (HD) or HDF. The number of patients treated by home HD at the end of 2014 was 529, a continued increase from that at the end of 2013 as 461.ConclusionsThe chronic dialysis population in Japan has been still increasing and becoming older year by year. The rapidly increasing number of online hemodiafiltration is an emerging trend but the penetration rate of home therapies by peritoneal dialysis and home hemodialysis was still the lowest in the world.Trial registrationUMIN000018641

Peritoneal Dialysis Registry With 2012 Survey Report.

Since 2009, the peritoneal dialysis (PD) registry survey has been carried out as part of the annual nationwide survey conducted by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy with the cooperation of the Japanese Society for Peritoneal Dialysis. In this report, the current status of PD patients is presented on the basis of the results of the survey conducted at the end of 2012. The subjects were PD patients who lived in Japan and participated in the 2012 survey. Descriptive analysis of various items was performed, which included the current status of the combined use of PD and another dialysis method such as hemodialysis (HD) or hemodiafiltration (HDF), the method of exchanging dialysate, the use of an automated peritoneal dialysis (APD) machine, and the rates of peritonitis and catheter exit‐site infection. From the results of the facility survey in 2012, the number of PD patients was 9514, a decrease of 128 from 2011. Among the entire dialysis patient population, 3.1% were PD patients, a decrease of 0.1%. Among the studied patients, 347 had a peritoneal catheter and underwent peritoneal lavage, 175 were started on PD in 2012 but introduced to other blood purification methods in the same year, and 1932 underwent both PD and another dialysis method such as HD or HDF. The percentage of patients who underwent PD and another dialysis method increased with PD vintage: <1 year, 4.8%; 1 to <2 years, 9.2%; 2 to <4 years, 16.3%; 4 to <8 years, 32.0%; and ≥8 years, 47.5%. The percentage of PD patients who completely manually exchanged the dialysate was 29.8%. The percentages of PD patients who used a double‐bag exchange system with ultraviolet‐light irradiation and those who used the same system but with a sterile connecting device were 54.7 and 13.9%, respectively. The percentage of patients on PD for <1 year using an APD machine was 43.4%, and it decreased with a PD vintage of ≥2 years. The mean rate of peritonitis was 0.22 per patient per year. The mean rate of catheter exit‐site infections was 0.36 per patient per year.

Genetic and environmental effects and characteristics of Japanese end-stage renal disease patients

Few studies of end‐stage renal disease (ESRD) investigate genetic and environmental effects simultaneously in one racial/ethnic group. United States Renal Data System data show racial differences in primary causes of ESRD, survival rates, and causes of death. Comparing these with Japanese Society for Dialysis Therapy data, survival rates appear better for Japanese than for US patients. To explore genetic and environmental differences, we investigated incident and prevalent ESRD patient characteristics. The United States Renal Data System and Japanese Society for Dialysis Therapy databases were analyzed between 1983 and 2002 for the following patient subsets: Americans excluding Asian Americans (n=1,153,974); Asian Americans excluding Japanese Americans (n=35,983); Hawaiian and non‐Hawaiian Japanese Americans by state, race, and Japanese surname (n=3932); native Japanese living in Japan (n=450,593). Japanese Americans tended to be older, male, have more diabetes and hypertension and less glomerulonephritis, and to die more often of heart failure than the other US groups. Adjusted mortality hazard ratios were 0.70 for non‐Japanese Asian Americans and 0.75 for Japanese Americans vs. non‐Asian Americans (1.00). Hawaiian Japanese patients tended to be older, with more diabetes and hypertension and less glomerulonephritis than the other Japanese groups; their survival rates improved after adjustment for rate of diabetes. Japanese American ESRD patients differ from Asian and non‐Asian Americans, and from native Japanese, despite similar genetic make‐ups. Both genetic and environmental factors may affect patient outcomes.