An Overview of Dialysis Treatment in Japan.

A statistical survey at the end of 1999 by the Japanese Society for Dialysis Therapy resulted in responses from 3, 220 (99.66%) of 3, 231 institutions providing dialysis. The survey found 197, 213 chronic dialysis patients in Japan, an increase of 6.4% (11, 891 patients) from the 1998 survey. The 1999 survey found a slight decrease in the gross annual mortality percentage compared to 1998 (9.7%). The mean age of patients newly introduced to dialysis increased to 63.4±13.9 (±SD) years in 1999. The mean age of the dialysis population at the end of 1999 was 60.6±13.3 years. The primary diseases leading to dialysis were diabetic nephropathy (36.2%) and chronic glomerulonephritis (33.6%).New survey items for 1999 survey included the following: 1) with/without reverse osmosis, 2) with/without dialysate endotoxin measurement and endotoxin concentration, 3) itchiness, 4) HBs and HBe antigen/antibody, 5) earlier hepatitis B vaccine inoculation, 6) HCV antibody/HCV-RNA, 7) serum glutamic pyruvic acid transaminase (GPT) activity, 8) hepatocellular carcinoma or cirrhosis, 9) previous limb amputation, 10) history of cerebral infarction, cerebral hemorrhage, or myocardial infarction, 11) loss of eyesight due to diabetic retinopathy or retinal circulatory disturbance, 12) serum cholesterol level, 13) number of cigarettes smoked, 14) platelet and leukocyte counts, 15) C-reactive protein levels, 16) height and body mass index (BMI), 17) tuberculosis within the previous year and 18) both the fluid substitution method in hemodiafiltration and the amount of substitution fluid.The survey findings for 1999 included 1) 93.0% of the patients were dialyzed using reverse osmosis 2) endotoxin concentrations tended to be lower in institutions with more patients, and 3) 56.7% of the patients experienced no itchiness and received no treatment for itchiness. Other survey findings were that 84.7% of the patients were HBs antigen (-) antibody (-), 1.9% were HBs antigen (+) antibody (-), and 13.0% were HBs antigen (-) antibody (+). The survey also found that 2.3% of patients were inoculated with Hepatitis B vaccine, 16.1% were HCV antibody (+), and 8.2% were HCV-RNA (+). The survey found that 2.1% of the patients had cirrhotic complications and 0.6% had hepatocellular carcinoma. The mean serum total cholesterol level was 162.84mg/dl, and the mean BMI was 20.61kg/m2. Using the Cox's proportional hazards model, a Kt/V of 1.4, a normalized protein catabolic rate of less than 0.9g/kg/day or more than 1.5g/kg/day, and a low creatinine generation rate were risk factors in the 6-year mid-term prognosis for hemodialysis patients.