Status Of Renal Replacement Therapy Research Articles

Current status of renal replacement therapy in Korea.

Hemodialysis (HD), peritoneal dialysis (PD), and transplantation are the three main replacement therapies for end-stage renal disease (ESRD). To be successful, dialysis requires advanced machines and transplantation requires an adequate number of donor organs. Since the late 1960s, when HD and PD were introduced, the number of dialysis centers and machines has continuously increased. More than 300 hospitals and clinics perform renal replacement therapy in Korea. Newly developed advanced dialysis machines and dialyzers have improved patient survival and quality of life. The development of nephrology as a subspecialty has also contributed to improvement in the treatment of ESRD. In Korea at the end of 2000, HD comprised 62% of renal replacement therapy, PD comprised 22%, and transplantation comprised 16%. In the field of transplantation, there has been tremendous improvement in outcomes and posttransplantation management. This improvement is due to newly developed, potent immunosuppressant medication, improved surgical skill, and improved methods of organ procurement and preservation. To review the current status of renal replacement therapy in Korea, the annual report of the Korean Society for Transplantation and Nephrology is reviewed and summarized in this article.

Current Status of Renal Replacement Therapy for Acute Renal Failure

Although the management of acute renal failure (ARF) constitutes a major component of the activities of practicing nephrologists, minimal information is available on the dialysis techniques utilized to treat ARF in the USA. It is evident from several recent publications that there are wide variations in the dialytic and nondialytic management of ARF. In order to obtain a better understanding of the current practice for dialytic management of ARF, the National Kidney Foundation (NKF) Council on Dialysis commissioned a survey of NKF members. This article describes the results of this survey and provides a snapshot of the current management practices for ARF. It is our hope that this information will provide a baseline for further research in this area.

Current status of renal replacement therapy in Japan: results of the annual survey of the Japanese Society for Dialysis Therapy

Beginning in 1966, the Patient Registration Committee of the Japanese Society for Dialysis Therapy has conducted a survey once a year on renal replacement therapy in Japan. As of 1983, the survey covered the life/death of patients in the survey years, as well as the case mix of individual patients. In 1990 several laboratory variables were added to the survey items. The present report summarizes the data from the 1993 and 1994 surveys. The Committee mailed out questionnaire forms at the end of the survey year to the heads of all dialysis facilities. Survey forms were returned from 99.6% of the dialysis facilities in the 1993 survey, and from 99.8% of the facilities in the 1994 survey. Some 143709 patients were treated by renal replacement therapy in 1994 (7509 were treated by CAPD, and 131016 by extracorporeal haemopurification). The gross mortality rate was 9.5% in the same year. The mean values of the laboratory variables among 88693 patients undergoing thrice weekly haemodialysis were as follows in 1993: Kt/V, 1.31 +/- 0.30; protein catabolic rate, 1.04 +/- 0.30 g/kg/day; haemodialysis time, 4.12 +/- 0.50 h. In 1994, the variables were: predialysis serum creatinine concentration, 11.54 +/- 2.85 mg/dl; predialysis serum albumin concentration, 3.91 +/- 0.55 g/dl; predialysis haematocrit, 28.69 +/- 4.36%.

Current status of renal replacement therapy in Japan: results of the annual survey of the Japanese Society for Dialysis Therapy

Beginning in 1966, the Patient Registration Committee of the Japanese Society for Dialysis Therapy has conducted a survey once a year on renal replacement therapy in Japan. As of 1983, the survey covered the life/death of patients in the survey years, as well as the case mix of individual patients. In 1990 several laboratory variables were added to the survey items. The present report summarizes the data from the 1993 and 1994 surveys. The Committee mailed out questionnaire forms at the end of the survey year to the heads of all dialysis facilities. Survey forms were returned from 99.6% of the dialysis facilities in the 1993 survey, and from 99.8% of the facilities in the 1994 survey. Some 143 709 patients were treated by renal replacement therapy in 1994 (7509 were treated by CAPD, and 131 016 by extracorporeal haemopurification). The gross mortality rate was 9.5% in the same year. The mean values of the laboratory variables among 88 693 patients undergoing thrice weekly haemodialysis were as follows in 1993: Kt/V, 1.31±0.30; protein catabolic rate, 1.04±0.30 g/kg/day; haemodialysis time, 4.l2±0.50 h. In 1994, the variables were: predialysis serum creatinine concentration, 11.54±2.85 mg/dl; predialysis serum albumin concentration, 3.91±0.55g/dl; predialysis haematocrit, 28.69±4.36%.

Current status of renal replacement therapy in Japan

The study of the current status of renal replacement therapy in Japan is based on the analysis of data from the registry reports for regular dialysis therapy and kidney transplantation. The total number of patients receiving regular dialysis therapy was 123,926 at the end of 1992: 117,809 (95.1%) on hemodialysis and 6,117 (4.9%) on peritoneal dialysis. The primary diseases of newly accepted patients were chronic glomerulonephritis (42.2%), diabetic nephropathy (28.4%), nephrosclerosis (5.9%), polycystic kidney disease (2.7%), chronic pyeronephritis (1.6%), and others. The number of kidney transplant patients in Japan was 8,384 at the end of 1991: 6,154 (73.4%) received a living donor transplantation and 2,230 (26.9%) received a cadaver donor transplantation. Overall 5-year survival rates of dialysis patients were 60.4%: 69.7% for chronic glomerulonephritis, 41.7% for diabetic nephropathy, 39.6% for nephrosclerosis, 73.6% for diffuse polycyustic kidney disease, and 66.6% for chronic pyeronephritis. The causes of death of dialysis patients were heart failure (31.1%), cerebrovascular accident (13.6%), infectious dieases (11.3%), malignancies (7.1%), cahexia/uremia (6.7%), myocardial infarction (5.8%), and others. The gross mortality rate of dialysis patients was increased in cases of less than 4 hours of the average length of each dialysis session, less than 4% and more than 9% of the average weight loss during each dialysis session, less than 1.0 of Kt/V, and less than 0.9 and more than 1.7 g/kg/d of protein catabolic rate. Overall 5-year patient and graft survival rates of kidney transplant patients since 1964 were 82.7% and 60.3%: 84.4% and 65.0% in living donor cases, and 77.4% and 46.2% in cadaver donor case, respectively. Those since 1983 were 90.1% and 68.2%: 91.3% and 72.6% in living donor cases, and 87.8% and 59.3%, respectively. Graft survival rates were superior in cases treated with combined steroid, cyclosporine and azathioprine or mizoribine, to those treated with other immunosuppressive regimens, and they decreased as the number of HLA-A, -B and -DR increased.