Dialysis Therapy In Japan Research Articles

Annual dialysis data report 2020, JSDT renal data registry

BackgroundThe 2020 Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) annual survey was sent to 4493 dialysis facilities in Japan.MethodsQuestionnaires were sent to all facilities that provide patients with dialysis therapy in Japan. Data were collected and compiled to form cross-sectional results of renal replacement therapy from various aspects.ResultsIn total, 4437 facilities (98.8%) responded to the facility questionnaire and 4271 (95.1%) responded to the patient questionnaire. The number of chronic dialysis patients in Japan continues to increase every year, reaching 347,671 at the end of 2020 and giving a prevalence rate of 2754 patients per million population. The mean age was 69.40 years. Diabetic nephropathy was the most common primary disease among the prevalent dialysis patients (39.5%), followed by chronic glomerulonephritis (25.3%) and nephrosclerosis (12.1%). There were 40,744 incident dialysis patients during 2020, representing a decrease of 141 from 2019. The average age of patients on dialysis was 70.88 years, with diabetic nephropathy being the most common underlying disease (40.7%) second most common was nephrosclerosis (17.5%), which was unchanged from the previous year and surpassed chronic glomerulonephritis (15.0%). There were 34,414 patient deaths in 2020; the crude mortality rate was 9.9%. The main causes of death were heart failure (22.4%), infection (21.5%), and malignancy (9.0%), which were almost the same as the percentages for the previous year. Since 2012, the number of patients treated by hemodiafiltration has increased rapidly; in 2020, the number of patients on this modality was 163,825, accounting for 47.1% of all patients on maintenance dialysis. The number of patients on peritoneal dialysis has been on the rise since 2017, reaching 10,338 in 2020; 20.8% of whom received combined therapy with hemodialysis or hemodiafiltration, showing no change from the previous year. A total of 751 patients were on home hemodialysis at the end of 2020, representing a decrease of 9 from the end of 2018. In 2020, coronavirus disease 2019 (COVID-19) infection and malignancy were added as new items in the survey. Continuing on from the 2019 survey, history of kidney donation for a living-donor transplant was investigated.ConclusionsPresent issues and challenges in renal replacement therapy were identified in the responses to the new questionnaire items included in this survey. A more detailed evaluation with adjustment for patient background factors should clarify the characteristics of the underlying diseases and conditions in dialysis patients.Trial registration The JRDR was approved by the Japanese Society for Dialysis Therapy ethics committee. It was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry on 10 September 2020 and in the UMIN clinical trials registration system (UMIN000018641).

A survey of environmental sustainability in Japanese dialysis facilities.

Dialysis practice has a particularly high environmental impact, including responsible for carbon emissions and climate change. Insufficient research has been conducted on environmental sustainability activities in dialysis therapy in Japan. We conducted an online Green Survey comprising 30 question items based on a previously conducted survey in Australia. Between August and September 2023, this was sent to members of the Japanese Association of Dialysis Physicians, including hospital and clinic physicians, working across 885 dialysis facilities in Japan. In total, 255 (29%) facilities responded to the survey. More than half of the facilities (n = 157; 61.6%) responded that they did not have a strategy, policy, or action plan for environmental sustainability. In four-fifths of the facilities (n = 208; 81.6%), no "green team" or committee had been formed to promote environmental protection. By contrast, most of the surveyed facilities had emergency strategies for natural disasters, such as covering for patient visits and staff commuting during extreme weather conditions (n = 169; 66.3%), water shortages (n = 159; 62.4%), and power outages (n = 188; 73.7%). Following the UK, Australia and New Zealand, and Portugal, this is the fourth Green Survey to be conducted, and the first on environmental sustainability among kidney health-care providers in Japan. The results indicated that daily activities for environmental protection are still lacking at many facilities, even though the management of dialysis treatment during a natural disaster is well conducted.

Annual dialysis data report 2019, JSDT Renal Data Registry

BackgroundThe Japanese Society for Dialysis Therapy is conducting the survey annually since 1968. The results provide a comprehensive picture of dialysis therapy in Japan. The survey for the year 2019 was performed as of December 2019.MethodsQuestionnaires were sent to all facilities that provide patients with dialysis therapy in Japan as an Excel file. Data were collected and compiled to form cross-sectional results of dialysis therapy from various aspects.ResultsAt the end of 2019, the annual survey of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) was conducted at 4487 dialysis facilities, of which 4411 facilities (98.3%) responded to the facility survey and 4238 facilities (94.5%) responded to the patient survey. The number of chronic dialysis patients in Japan continues to increase every year; it reached 344,640 at the end of 2019, and the prevalence ratio of dialysis patients was 2732 per million population. In the patient survey, the mean age of prevalent dialysis patients was 69.09 years. The most prevalent primary disease among prevalent dialysis patients was diabetic nephropathy (39.1%), followed by chronic glomerulonephritis (25.7%) and nephrosclerosis (11.1%). In 2019, there were 40,885 new patients on dialysis, an increase of 417 over 2018. The average age of incident dialysis patients was 70.42 years, and diabetic nephropathy (41.6%) was the most common cause. The second cause was nephrosclerosis, followed by glomerulonephritis. As 34,642 patients passed away in 2019, the crude mortality rate for the year was 10.1%. Heart failure (22.7%), infectious disease (21.5%), and malignancy (8.7%) were the three leading causes of death. Since 2012, the number of patients treated by hemodiafiltration (HDF) has increased substantially. The figure reached 144,686 by year's end, representing 42.0% of all dialysis patients. In 2019, the number of peritoneal dialysis (PD) patients was 9,920, a small rise from 2017. 19.2% of PD patients also received hemodialysis (HD) or HDF to compensate for the reduction in dialysis dosage or in fluid removal by PD alone (hybrid therapy). At the end of 2019, 760 patients received home HD therapy, an increase of 40 from 2018. In 2019, a detailed survey was conducted on the current status of CKD-MBD treatment, 10 years after the previous survey in 2009. The clinical efficacy of newly released medications during this time period and the impact of the 2012 revisions to the CKD-MBD guidelines require further investigation. These analyses would serve as the foundation for the next revision of the CKD-MBD guidelines and may reveal deeper therapeutic insights regarding CKD-MBD.ConclusionsThe results obtained by the survey revealed the comprehensive practice patterns of dialysis therapy and served as a basis for future guidelines.Trial registration: JRDR was approved by the ethics committee of JSDT (approval number 1–5) and registered in the "University hospital Medical Information Network (UMIN) Clinical Trials Registry" on 10th September 2019 with a clinical trial ID of UMIN000018641. https://upload.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000021578 (Accessed 20 November 2020).

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慢性透析療法を受けているHIV陽性患者数―HIV/エイズ拠点病院の最新データに基づく調査―

本邦における維持透析患者のHIV感染陽性率

本邦における維持透析患者のHIV感染陽性率

Cues for Nursing Diagnosis of Ineffective Self‐management of Fluid and Dietary Restrictions in Dialysis Therapy in Japan

We aimed to identify the cues of expert nurses and validate the cue information on the defining characteristics for a nursing diagnosis of ineffective self-management of fluid and dietary restrictions in dialysis therapy in Japan. We used qualitative interviews and two-round Delphi studies. The expert nurses regarded four signs of unmaintained fluid and dietary restrictions as major defining characteristics and nine other cues as minor defining characteristics. Expert nurses in dialysis therapy regard symptoms of health behavior as major cues for nursing diagnosis of ineffective self-management of fluid and dietary restrictions in dialysis therapy. Verification of the clinical validity and development of a specific, clinically useful database on nursing diagnoses are required.

Information-Sharing System for Disaster Recovery of Dialysis Therapy in Japan

If a natural disaster or other event causes damage that makes dialysis therapy impossible, what steps should be taken? Many actions will be required, including disaster recovery activities in the affected area as well as the performance of dialysis at substitute dialysis facilities outside the affected area. The Japanese Association of Dialysis Physicians (JADP), in collaboration with the Japan Association for Clinical Engineering Technologists (JACET), operates an "information sharing system" that will be essential when carrying out post-disaster activities. This system consists of a website and mailing lists on the Internet, and it has been used in 11 disasters so far.The JADP is an organization of doctors engaged in dialysis therapy. This association conducts investigation and research, education, and crisis management for dialysis therapy. The JACET is an organization that aims to enhance scientific knowledge and skills and to improve capabilities. This association also pursues improvement of the reliability of medical care involving life support systems and other medical equipment.

The Most Recent Trends of Peritoneal Dialysis in Japan

By 31 December 2006, more than 260,000 patients were on dialysis therapy in Japan, and 9,243 of them (3.6%) were on peritoneal dialysis (PD). The mean age of PD patients was 5 years less than that of all patients with chronic kidney disease, and the prevalence of diabetes among them was 9.4% lower. Among the PD patients, 18.0% were being treated with a combination of PD and hemodialysis, and 33.4% were being treated with automated PD. A peritoneal equilibration test (PET) had been performed in 22.0% of the patients, who were then classified into the four PET categories. Of the tested patients, 10.3% were placed in the low (L) category; 38.3% in the low-average (LA) category; 38.4%, in the high-average (HA) category; and 13.0%, in the high (H) category. Icodextrin was used by 27.3% of patients classified L, 30.5% of those classified LA, 47.1% of those classified HA, and 55.1% of those classified H. The annual death rate was 6.1%, which was lower than the rate for HD (9.7%); and the annual withdrawal rate was 19.8%. Infectious complications were the main cause for lowered rates of patient and technique survival. Use of PD for older and diabetic patients and of combination therapy with hemodialysis are key perspectives in the most recent report on PD in Japan.

Increasing Gender Difference in the Incidence of Chronic Dialysis Therapy in Japan

The incidence of chronic kidney disease and its progression to end-stage renal disease (ESRD) differs between genders, so it can be surmised that the incidence of ESRD is different between men and women. We analyzed the annual incidence of ESRD by gender for a 20 year period, from 1983 to 2002, using Japanese Society for Dialysis Therapy (JSDT) registration data. The annual incidence of ESRD was calculated as the number of incident dialysis patients divided by the census population of the previous year in each gender, and expressed per million of each population (male and female). In men, the incidence of ESRD increased from 99.9 in 1983 to 330.2 in 2002, whereas it was 66.6 in 1983 and 184.9 in 2002 in women. The difference of incidence of ESRD from men to women increased from 33.3 in 1983 to 145.3 in 2002. The mean age at the start of dialysis was 51.5 years (men) and 52.5 years (women) in 1983, it increased to 63.8 years (men) and 66.1 years (women) in 2002. The difference in mean age increased from 0.9 years in 1983 to 2.3 years in 2002. There was no clear relationship between the available dialysis station per 100,000 population and the men to women ratio in the prevalent dialysis patients among the 47 prefectures. The acceptance of dialysis therapy might not be strong enough to explain the increasing difference in ESRD incidence between men and women in Japan. Differences in the socioeconomic conditions and lifestyles between men and women, which might be related to the gender difference in incidence in ESRD, should be studied further.

Pathogenesis of diabetic nephropathy

Diabetic nephropathy is one of the most serious complications among patients with long-standing diabetes mellitus. In recent years, nearly one third of the patients newly admitted to dialysis therapy in Japan suffer from diabetic nephropathy. Hyperglycemia appears to play a major role in the pathogenesis of this disease, probably via glomerular hemodynamic changes, as well as via metabolic alterations in glomerular cells, although both pathways may interact with each other. Recently, an activation of protein kinase C has been advocated to be a critical mediator between hyperglycemia and diabetic nephropathy. Protein kinase C is known to induce the production of various extracellular matrix proteins, which may cause the expansion of glomerular mesangium. Administration of a specific inhibitor of the β isoform of protein kinase C corrected glomerular hyperfiltration in diabetic rats. In addition, genetic factors may be involved in the progression of diabetic nephropathy, since various clinical studies have indicated the familial clustering of this complication in diabetes mellitus. Although the association with gene polymorphism of angiotensin-converting enzyme has been extensively studied by several individual research groups, a decisive conclusion has not been obtained. Further research using multicenter studies enrolling large numbers of patients may be needed to detect nephropathic gene(s).

Current status of Type 2 (non-insulin-dependent) diabetic subjects on dialysis therapy in Japan

According to a national survey of dialysis patients in Japan conducted by the Japanese Society for Dialysis Therapy, there were 1,033 patients on dialysis in the Shiga area which has a population of about 1.2 million. Of these 1,033 dialysis patients 140 were the result of diabetic nephropathy. From four hospitals affiliated to Shiga University of Medical Science the medical records of 90 diabetic subjects on dialysis therapy were reviewed and various clinical parameters were analysed and compared with those of patients with chronic glomerulonephritis. Since only one patient had Type 1 (insulin-dependent) diabetes, the remaining 89 with Type 2 (non-insulin-dependent) diabetes were used for this study. The significantly different variables between patients with Type 2 diabetes and chronic glomerulonephritis were age (60.4 vs 54.6 years, p < 0.05), BMI (22.4 vs 20.6 kg/m2, p < 0.001), cardiothoracic ratio (56.4 vs 53.3%, p < 0.001), mean blood pressure (110 vs 117 mmHg, p < 0.05), serum creatinine (9.0 vs 11.5 mg/dl, p < 0.001), serum urea-N (98.2 vs 115.5 mg/dl, p < 0.001), serum total protein (6.0 vs 6.5 g/dl, p < 0.001) and serum albumin (3.5 vs. 3.9 g/dl, p < 0.001). Serum levels of cholesterol and triglyceride were not significantly different between two groups, though the prevalence of electrocardiogram abnormalities, oedema, neuropathy, myocardial infarction and cerebrovascular diseases was significantly higher in the Type 2 diabetic group. These results suggested that Type 2 diabetic patients with end-stage renal disease were older, more malnourished, fluid overloaded and multi-morbid as a result of vasculopathy and neuropathy.(ABSTRACT TRUNCATED AT 250 WORDS)