Renal replacement therapy in Japan: better outcome than in the USA.

Abstract

1. Gross patient mortality is lower than in the USA. 2. The dose of dialysis administered as judged by either duration of treatment sessions or calculated Kt/Vis higher in Japan than in the USA. 3. Attained predialysis serum creatinine concentration and mean haematocrit are approximately equivalent in Japan and the USA. 4. Mean haematocrit does not correlate with mean blood pressure; raising haematocrit with erythropoietin does not induce hypertension (Table 3). 5. Differences in expression of renal failure in Japan and the USA are evident. For example, the proportion of male dialysis patients in Japan (59.1%) is higher than in the USA (53.4%), reflecting either selection-exclusion bias or dissimilar pathogenetic factors. Further to this point, the fraction of dialysis patients who are diabetic is about 10% less in Japan than in the USA. Fewer diabetics mean better group survival. A very low kidney transplant rate in Japan means that fit, younger patients who are removed from the dialysis pool in the USA are retained on dialysis in Japan, improving the overall case-mix profile.