Skip to content

Advertisement

  • Position statement
  • Open Access

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

  • 1, 2Email author,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Renal Replacement Therapy20173:18

https://doi.org/10.1186/s41100-017-0097-8

  • Received: 18 January 2017
  • Accepted: 3 February 2017
  • Published:

Abstract

Background

The 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.

Methods

The 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.

Results

The 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 69.04 years, and the mean age of the prevalent dialysis patients was 67.54 years. 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 3 years. 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.

Conclusions

The 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 registration

UMIN000018641

Keywords

  • Dialysis patient population
  • Survival rate
  • Dialysis fluid quality
  • Hemodiafiltration
  • Peritoneal dialysis

Outline of JSDT Renal Data Registry

Introduction

The Japanese Society for Dialysis Therapy (JSDT) has been annually surveyed the status of chronic dialysis since 1968, and it was named the JSDT renal data registry (JRDR). In the early surveys, only the counts of patients and dialysis-beds in dialysis facilities were recorded annually. Since 1983, clinical data of all dialysis patients treated in the facilities that participated in the surveys have been collected. The results from these surveys were summarized as the annual renal data report and also used for making JSDT guidelines and standards. JRDR is respected worldwide as an unbiased complete patient census.

Before 2014, the results from JRDR had been reported in following three types of report. First, quick analyses of the data obtained by April in the following year were reported at the annual meeting of the JSDT held in June and compiled in “The Atlas, Overview of Regular Dialysis Treatment in Japan”. Second, the responses to the survey had been continuously collected until September, and the obtained data were screened to determine the definite survey results, which were published in the “An Overview of Regular Dialysis Treatment in Japan, the CD-ROM Report”. Third, the tabulated results based on the definite values in the CD-ROM report were published as an annual dialysis data report in the Journal of Japanese Society for Dialysis Therapy. Therefore, the values in the atlas were different from the definite values in the CD-ROM. The quick estimations were prepared only for the atlas in the annual meeting of JSDT. However, the values in the atlas had been occasionally cited as if they were officially approved values because they were expressed by attractive graphs. To avoid these mal-citations, we decided to publish all the official reports from the 2014 survey based on the definite database.

All the figures and tables included in the CD-ROM report have been made available on the members-only pages of the JSDT website since 2012 to widely provide the survey findings among JSDT members. These pages contain all the findings from the first survey conducted in 1968 to the latest survey. All figures and tables in the website in JRDR have been updating if any errors had been found so these updated data should be used for any academic and social analyses. On the other hand, the summaries of survey results in the illustrated report are available for the general public on the JSDT website (http://www.jsdt.or.jp/overview_confirm.html). A review report should be referred for the historical background of the annual survey and the survey items in the previous surveys [1].

The current manuscript is the second publication of An overview of regular dialysis treatment in Japan (as of December 31, 2014) J Jpn Soc Dial Ther 49(7):1–34, 2016, written in Japanese.

Subjects and methods

Survey method

The JSDT survey is conducted annually by sending questionnaires to all dialysis facilities in Japan at the end of each year. A total of 4367 facilities surveyed were either member facilities of JSDT, nonmember facilities offering regular maintenance hemodialysis (HD), or nonmember facilities offering peritoneal dialysis (PD) but not HD as of 31 December 2014. The number of facilities participating in this survey increased by 42 (1.0%) from 2013 as 4325 facilities [2].

The questionnaires were mainly sent and collected by postal mail; the rest of them were also faxed. Universal serial bus (USB) memory devices with stored electronic spreadsheets in Microsoft Excel format were also sent with the printed questionnaires to the facilities. The facilities were requested to use these devices for the completion of the questionnaires as much as possible.

In this survey, two sets of questionnaires were used. One was for the facility survey, which included questions about dialysis facilities, such as the number of patients and the number of staff members. The other was for the patient survey, which included items on the epidemiological background, treatment conditions, and the outcome of the treatment of individual dialysis patients.

The deadline for the acceptance of responses was the end of January in 2015. The acceptance of responses submitted after this deadline, including those of the additional surveys, ended on 7 August 2015.

As previously addressed, we decided to publish the annual report based on the definite database from 2014, so all values in this report are officially approved and the same as those in the CD-ROM. Based on the defined database, the count of facilities that responded to the facility survey was 4330 (99.2%), and the count of facilities that responded to both the facility and patient surveys was 4191 (96.0%). Moreover, the facilities that completed the questionnaires using the electronic medium (3764 facilities, 86.9%) further increased from the 2013 survey (3698 facilities, 86.6%). This increase contributed to the accurate and simplified analysis of survey data [3].

Survey items

The collected data in the 2014 survey were classified to the following two categories as facility data and patient data. The items in the previous surveys are found on the members-only pages of the JSDT website (http://www.jsdt.or.jp/).

Facility survey

The following are the items surveyed in the 2014 survey and are the same as those in the 2013 survey [2].
  • Name and contact numbers (TEL, FAX) of facility

  • Year and month when the facility started providing dialysis treatment

  • Capacity for simultaneous hemodialysis treatments

  • Maximum capacity for hemodialysis treatments

  • Number of bedside consoles

  • Number of workers involved in dialysis treatment (e.g., doctors, nurses, clinical engineers, nutritionists, case workers)

  • Number of dialysis specialists

  • Number of prevalent dialysis patients at the end of 2014 (daytime dialysis, nighttime dialysis, home HD, PD)

  • Number of HD/HDF patients with PD catheter (non-PD + catheter patients)

  • Number of patients treated by the combination of PD and HD/HDF (PD + HD patients)

  • Number of inpatients on dialysis at the end of 2014

  • Number of incident dialysis patients

  • Number of the incident PD patients who changed a dialysis modality during 2014 (PD dropout patients)

  • Number of deceased patients during 2014

  • Number of bedside consoles equipped with an endotoxin retentive filter (ETRF)

  • Use or nonuse of ETRFs for sampling dialysis fluid

  • Sampling site of dialysis fluid

  • Frequency for measuring endotoxin concentration in dialysis fluid

  • Endotoxin concentration in dialysis fluid

  • Frequency for measuring total viable microbial count (TVC) in dialysis fluid

  • Sampling volume for TVC

  • Cultivation medium for TVC

  • TVC in dialysis fluid

  • Patient survey

The following are the basic survey items that have been annually surveyed since 1983.
  • Anonymized name

  • Gender

  • Date of birth

  • Year and month of start of dialysis

  • Year and month of transfer from another hospital

  • Primary disease

  • Residence (prefecture)

  • Dialysis modality

  • Outcome (transfer, death, dropout, or transplantation)

  • Outcome date

  • (in case of facility transfer) Facility code

  • Cause of death

The following were added to the above basic survey items and were surveyed using both paper and electronic media.
  • Current status of the combination of PD + HD

  • Treatment history of PD

  • Number of past renal transplantations

  • Frequency of dialysis session per week

  • Dialysis time per session

  • Blood flow rate

  • Dilution mode in HDF

  • Substitution fluid volume per HDF session

  • Body height

  • Predialysis and postdialysis body weight

  • Predialysis and postdialysis blood urea nitrogen (BUN) concentration

  • Predialysis and postdialysis serum creatinine concentration

  • Predialysis serum albumin concentration

  • Predialysis serum C-reactive protein (CRP) concentration

  • Predialysis serum calcium concentration

  • Predialysis serum phosphorus concentration

  • Measurement method for serum parathyroid hormone (PTH) concentration

  • Intact and whole PTH concentration

  • Predialysis hemoglobin (Hb) concentration

  • Use or nonuse of antihypertensive agent

  • Smoking habit

  • History of diabetes

  • History of myocardial infarction

  • History of cerebral hemorrhage

  • History of cerebral infarction

  • History of major amputation

  • History of femoral neck fracture

  • History of encapsulating peritoneal sclerosis (EPS)

The following were added to the basic survey items and were collected only by the USB survey.
  • Serum total cholesterol concentration

  • Serum high-density lipoprotein cholesterol (HDL-C) concentration

  • Predialysis systolic blood pressure

  • Predialysis diastolic blood pressure

  • Predialysis pulse rate

The following were surveyed only for PD patients and were collected only by the USB survey.
  • PD vintage

  • Number of months in which PD was performed in 2014

  • History of peritoneal equilibrium test (PET)

  • Four-hour creatinine concentration dialysate/plasma ratio in PET (PET Cr D/P ratio)

  • Type of PD fluid (PD fluid type)

  • Volume of PD fluid per day (PD fluid volume)

  • PD treatment time per day

  • Daily urine volume (Urine volume)

  • Mean ultrafiltration (UF) volume per day (UF volume)

  • Kt/V by residual kidney (Residual kidney Kt/V)

  • Kt/V by PD (PD Kt/V)

  • Changing maneuver of PD fluids

  • Use or nonuse of automated peritoneal dialysis (APD) machine

  • Past histories of peritonitis during 2014

  • Past histories of exit-site infections during 2014

Calculation of survival rate

The cumulative survival rate after the start of dialysis was actuarially calculated [4].

Contents of the 2014 annual dialysis data report of JSDT

  1. I.

    Outline of JSDT Renal Data Registry (JRDR)

     
  2. II.

    Results and discussion from JRDR

     
  • Chapter l: Basic demographics

  • Chapter 2: Current status of microbiological quality of dialysis fluid and its control

  • Chapter 3: Current status of hemodiafiltration

  • Chapter 4: Current status of peritoneal dialysis

  • II. Results and discussion from JRDR

Chapter 1: Basic demographics

Number of dialysis patients

Table 1 shows a summary of the dynamics of dialysis patients in Japan at the end of 2014. The number of facilities that responded to the facility survey in 2014 was 4330, an increase of 62 (1.4%) from 4268 facilities in 2013. Dialysis facilities have been continuously increasing by 100 or less every year since 2000. In Table 1, data on dialysis vintage and the longest dialysis vintage were obtained from the patient survey. All the other results were obtained from the facility survey.
Table 1

Summary of chronic dialysis therapy in 2014

Number of facilities

 

4330 facilities

(increase of 62 facilities, 1.5% increase)

 

Equipment

Number of bedside consoles

131,555 units

(increase of 3405 units, 2.7% increase)

 

Capacity

Capacity for simultaneous HD treatments

129,860 treatments

(increase of 3600 patients, 2.9% increase)

 
 

Maximum capacity

432,433 patients

(increase of 10,272 patientns, 2.4% increase)

 

Prevalent dialysis patients

Daytime

269,393 patients

(84.1%)

  

Nighttime

41,271 patients

(12.9%)

  

Home HD

529 patients

(0.2%)

  

PD

9255 patients

(2.9%)

  

Total prevalent dialysis patients

320,448 patients

(100.0%)

(increase of 6010 patients)

 

Adjusted prevalent patient count (pmp)

2517.3 patients

(increase of 47.2 patients)

  

Number of PD + HD patientsa

1913 patients

   

Number of non-PD + catheter patientsb

278 patients

   

Number of PD dropout patientsc

193 patients

   

Incident dialysis patients

38,327 patients

(increase of 232 patients, 0.6% increase)

 

Deceased patients in 2014

30,707 patients

(increase of 44 patients, 0.1% decrease)

 

The above data were obtained from the facility survey.

Dialysis vintage (years)

Male

Female

Unspecified

Total

(%)

0, <5

98,411

47,674

0

146,085

(47.1)

5, <10

49,893

27,969

0

77,862

(25.1)

10, <15

24,330

15,702

0

40,032

(12.9)

15, <20

12,178

9035

0

21,213

(6.8)

20, <25

6368

5434

0

11,802

(3.8)

25, <30

3450

3101

0

6551

(2.1)

30, <35

2091

1869

0

3960

(1.3)

35

1359

1158

0

2517

(0.8)

Subtotal

198,080

111,942

0

310,022

(100.0)

Unknown/no information available

61

25

 

86

 

Total

198,141

111,967

0

310,108

 

Longest dialysis vintage

 

46 years and 6 months

   

The above data were obtained from the patient survey.

aPD + HD patients: Patients treated by the combination of PD and HD, HDF, hemoadsorption, or hemofiltration (excluding those who underwent only peritoneal lavage)

bNon-PD + catheter patients: Patients who did not undergo PD despite having a peritoneal catheter but underwent HD, HDF, hemoadsorption, or hemofiltration (including those who underwent only peritoneal lavage)

cPD dropout patients: Incident PD patients who changed a dialysis modality during 2014

pmp per million population

As determined from the facility survey, the prevalent dialysis patients in Japan at the end of 2014 were 320,448 (Table 1). Table 2 shows changes in number of prevalent, incident, and deceased dialysis patients over the last 20 years. The number of dialysis patients in 2014 increased by 6010, which was greater than 4431 in 2013. However, the increasing rate in prevalent dialysis patients has generally decreased since 2000. The annual increasing rate of the prevalent dialysis patients is defined as the ratio of the increase in dialysis patients each year to the dialysis patients at the end of the previous year. The future trend of dialysis patient population in Japan has been estimated by assuming that this trend of annual rate increase continues in the future. As reported previously, the dialysis patient population in Japan is expected to reach the maximum (approximately 348,000) around 2021 and then start decreasing [5].
Table 2

Prevalent, incident, and deceased dialysis patient counts and adjusted rate

 

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Prevalent dialysis patients

154,413

167,192

175,988

185,322

197,213

206,134

219,183

229,538

237,710

248,166

Incident dialysis patients

26,398

28,409

28,870

29,641

31,483

32,018

33,243

33,710

33,966

35,084

Deceased dialysis patients

14,406

15,174

16,102

16,687

18,524

18,938

19,850

20,614

21,672

22,715

Adjusted prevalent dialysis patients (pmp)

1229.7

1328.4

1394.9

1465.2

1556.7

1624.1

1721.9

1801.2

1862.7

1943.5

Recovery rate for facility survey (%)

99.8

99.8

99.7

99.7

99.7

99.9

99.0

99.6

99.1

98.7

 

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Prevalent dialysis patients

257,765

264,473

275,242

283,421

290,661

298,252

304,856

310,007

314,438

320,448

Incident dialysis patients

36,063

36,373

36,934

38,180

37,566

37,512

38,613

38,055

38,095

38,327

Deceased dialysis patients

23,983

24,034

25,253

27,266

27,646

28,882

30,743

30,710

30,751

30,707

Adjusted prevalent dialysis patients (pmp)

2017.6

2069.9

2154.2

2219.6

2279.5

2329.1

2385.4

2431.2

2470.1

2517.3

Recovery rate for facility survey (%)

98.9

98.4

98.9

99.0

98.5

98.6

99.0

99.0

98.7

99.2

The above counts were from the facility surveys

The number of incident dialysis patients was 38,327 in 2014, as shown by the facility survey. The annual number of incident dialysis patients continued to increase from the start of the survey. Since 2008, incident dialysis patients remained around 38,000 (Table 2).

The annual increasing rates of incident dialysis patients from 2002 adjusted by the recovery rate for the facility survey are plotted in Fig. 1, similarly to the 2013 survey [2]. According to the regression line for the annual increasing rates of incident dialysis patients, the turning point when the incident dialysis patients stop increasing was expected to be in 2013, as shown in the 2013 survey report [2]. These lines of evidences suggested that incident dialysis patients will gradually decrease in the future.
Fig. 1
Fig. 1

Annual increasing rate of incident dialysis patients

The total count of deceased dialysis patients in 2014 was 30,707 (Table 1). The annual count of deaths continued to increase until 2011, but it has been around 30,000 since 2012 [2]. Similarly to the previous report, the trend of the annual increasing rates of deceased patients over the past 12 years from 2002 was examined (Fig. 2). The increasing rate of deaths remained around 4% until 2011 with slight yearly fluctuations. However, the increasing rates following 3 years (2012–2014) was almost 0%. The regression line for the increasing rates of the annual number of deaths between 2012 and 2014 is obviously decreasing. If this trend continues, the annual number of deaths stops increasing in 2017. However, it can also be interpreted that the rate of increase in the annual number of deaths has fluctuated since 2012, requiring careful attention to future trends.
Fig. 2
Fig. 2

Annual increasing rate of deceased dialysis patients

In the 4330 facilities that responded to the facility survey questionnaire, the total number of bedside consoles was 131,555, an increase of 3405 (2.7%) from the previous year. The capacity for simultaneous hemodialysis treatments in all facilities was 129,860, and the capacity for the maximum dialysis patients was 432,433, increases of 2.9 and 2.4% from the previous year, respectively. As mentioned above, the total number of patients on chronic dialysis in Japan is expected to reach a maximum of approximately 348,000 in 2021 and then gradually decrease; this is expected even when taking into consideration the number of patients treated in dialysis facilities that did not respond to this survey [5]. Therefore, the capacity for dialysis patients in 2014 had been already larger than the expected number of the maximum dialysis patients.

The percentage of patients on daytime dialysis was 84.1% of the dialysis patients in 2014, which was 0.4% higher than the previous year (Table 1). In contrast, the nighttime dialysis patient was 12.9%, which was 0.3% lower than 13.2% in the previous year. The absolute number of patients on nighttime dialysis remained in the range of 41,000–42,000 over the last 10 years (Table 3). The number of patients on home HD was 529, an increase of 68 (14.8%) from 461 in the previous year and which has been increasing rapidly since 2006 (Table 3).
Table 3

Modalities in prevalent dialysis patients

 

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Facility surveya

Prevalent dialysis patient

248,166

257,765

264,473

275,242

283,421

290,661

298,252

304,856

310,007

314,438

320,448

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Daytime dialysis patient

196,337

206,340

213,454

223,953

231,517

238,848

246,146

253,916

258,131

263,184

269,393

(%)

(79.1)

(80.0)

(80.7)

(81.4)

(81.7)

(82.2)

(82.5)

(83.3)

(83.3)

(83.7)

(84.1)

Nighttime dialysis patient

42,600

41,871

41,641

41,742

42,405

41,719

42,052

40,971

41,969

41,401

41,271

(%)

(17.2)

(16.2)

(15.7)

(15.2)

(15.0)

(14.4)

(14.1)

(13.4)

(13.5)

(13.2)

(12.9)

Home HD patient

114

127

147

187

193

236

277

327

393

461

529

(%)

(0.0)

(0.0)

(0.1)

(0.1)

(0.1)

(0.1)

(0.1)

(0.1)

(0.1)

(0.1)

(0.2)

PD patientc

8774

9243

9003

9362

9300

9858

9773

9642

9514

9392

9255

(%)

(3.5)

(3.6)

(3.4)

(3.4)

(3,3)

(3.4)

(3.3)

(3.2)

(3.1)

(3.0)

(2.9)

PD + HD patientd

     

1720

1983

1902

1932

1920

1913

non-PD + catheter patiente

     

437

406

369

347

292

278

Patient surveyb

Prevalent dialysis patient

236,606

240,513

249,957

264,356

273,237

281,996

289,449

295,735

301,545

306,925

310,108

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

HD

213,474

216,880

223,737

235,960

245,090

253,807

262,973

270,072

268,275

264,211

255,641

(%)

(90.2)

(90.2)

(89.5)

(89.3)

(89.7)

(90.0)

(90.9)

(91.3)

(89.0)

(86.1)

(82.4)

HDF

14,183

14,083

16,163

17,759

17,380

16,853

14,867

14,115

21,725

31,371

43,283

(%)

(6.0)

(5.9)

(6.5)

(6.7)

(6.4)

(6.0)

(5.1)

(4.8)

(7.2)

(10.2)

(14.0)

PDc

8004

8103

7971

8630

8636

9164

9298

9094

8996

9037

8941

(%)

(3.4)

(3.4)

(3.2)

(3.3)

(3.2)

(3.2)

(3.2)

(3.1)

(3.0)

(2.9)

(2.9)

aData obtained from the facility survey

bData obtained from the patient survey

cThe figures mean “number of CAPD patients” from 2002 to 2008 (CAPD: continuous ambulatory peritoneal dialysis)

dPD + HD patients: patients treated by the combination of PD and HD or HDF

eNon-PD + catheter patients: HD or HDF patients with PD catheter

The prevalent patients on PD was 9255, which was 2.9% of all dialysis patients. Although the number of PD patients was maximum at 9858 in 2009, it had been gradually decreasing since then (Table 3). The count of PD + HD patients was 1913 in the 2014 survey, and it had remained around 1900 since 2009. The count of non-PD + catheter patients, it was probably for peritoneal lavage, was 278 and that of PD dropout patients during 2014 was 193.

As shown in Table 3, the number of hemodiafiltration (HDF) patients had been rapidly increasing since 2012 and reached 43,283 in 2014. The demographics of HDF patients are described in detail in Chapter 3: Current status of hemodiafiltration.

According to the patient survey, the longest dialysis vintage was 46 years and 6 months (Table 1). Table 4 shows the total number of dialysis patients in each prefecture of Japan determined from the facility survey.
Table 4

Prevalent dialysis patient counts by modality and prefecture

Prefecture

Daytime

Nighttime

Home HD

PD

Total

Outpatients

Inpatients

Outpatients

Inpatients

Outpatients

Inpatients

Outpatients

Inpatients

Hokkaido

11,733

1793

1277

32

10

0

384

10

15,239

Aomori

2885

226

231

2

0

0

85

3

3432

Iwate

2390

219

332

3

0

0

95

5

3044

Miyagi

4030

346

813

36

0

0

86

6

5317

Akita

1597

258

134

0

2

0

54

5

2050

Yamagata

1953

252

310

0

10

0

66

4

2595

Fukushima

3852

368

400

1

1

0

169

12

4803

Ibaraki

6098

600

885

0

5

0

112

15

7715

Tochigi

4736

431

704

0

2

0

86

2

5961

Gunma

4200

563

906

17

7

0

95

2

5790

Saitama

13,574

1080

1837

31

80

0

266

6

16,874

Chiba

10,972

1105

1630

10

6

0

270

4

13,997

Tokyo

22,033

2484

4919

112

65

1

1017

20

30,651

Kanagawa

14,710

1524

3082

41

32

0

530

74

19,993

Niigata

3607

291

971

12

1

0

155

3

5040

Toyama

1794

342

270

1

2

0

97

4

2510

Ishikawa

2019

237

316

0

2

0

68

1

2643

Fukui

1325

153

212

7

3

0

82

4

1786

Yamanashi

1800

117

246

0

1

0

58

0

2222

Nagano

3823

354

732

2

4

0

127

5

5047

Gifu

3672

439

610

7

22

0

81

3

4834

Shizuoka

8119

831

1289

4

12

0

174

9

10,438

Aichi

12,379

1397

3027

41

48

0

672

17

17,581

Mie

3333

387

498

18

5

0

78

1

4320

Shiga

2147

299

439

4

31

0

135

7

3062

Kyoto

4534

510

913

100

11

0

202

4

6274

Osaka

17,336

2087

2696

76

36

0

523

20

22,774

Hyogo

10,353

1081

1601

22

55

0

232

32

13,376

Nara

2699

234

265

2

6

0

152

3

3361

Wakayama

2357

279

264

23

16

0

38

1

2978

Tottori

1147

111

138

0

0

0

57

10

1463

Shimane

1203

104

142

0

1

0

57

8

1515

Okayama

3511

547

555

24

1

4

179

18

4839

Hiroshima

5603

844

636

2

22

1

350

27

7485

Yamaguchi

2561

477

315

5

0

0

132

5

3495

Tokushima

2106

260

241

1

4

0

160

13

2785

Kagawa

1932

273

210

3

8

0

184

5

2615

Ehime

2809

471

379

6

0

0

140

3

3808

Kochi

1694

303

260

31

0

0

20

4

2312

Fukuoka

10,276

1222

2171

62

3

0

641

20

14,395

Saga

1763

260

295

9

1

0

14

2

2344

Nagasaki

2924

386

482

9

3

0

129

3

3936

Kumamoto

4667

640

900

3

1

0

149

2

6362

Oita

2916

487

325

5

3

0

146

2

3884

Miyazaki

2954

292

506

12

0

0

53

2

3819

Kagoshima

3928

669

531

24

1

0

127

24

5304

Okinawa

3297

409

576

0

0

0

96

2

4380

Total

241,351

28,042

40,471

800

523

6

8823

432

320,448

All figures were from the facility survey. They do not necessarily meet the total number of patients counted in accordance with dialysis modality

Mean age

The dialysis patient population in Japan is aging yearly. Table 5 shows the changes in the mean age of the prevalent and incident dialysis patients obtained from the patient survey. The mean age of the incident dialysis patients in 2014 was 69.0 ± 13.4 years [mean ± standard deviation (S.D.)] and that of the prevalent dialysis patients was 67.5 ± 12.5 years. In last two decades from 1994 to 2014, the mean age of dialysis patients had become 6.0 years older from 57.3 to 63.3 years in the first decade, and 4.2 years older from 63.3 to 67.5 years in the second decade. Similarly, the mean age of incident dialysis patients had become 5.3 years older from 60.4 to 65.8 years in the first decade and from 65.8 to 69.0 years in the second decade. These findings showed that the rate of aging of both prevalent and incident dialysis patients was also slowing down. The incident patient distribution by gender and age was summarized in Table 6, and the prevalent patient distribution by gender and age was summarized in Table 7.
Table 5

Mean age of prevalent and incident dialysis patients

 

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Mean age of the prevalent dialysis patients

56.6

57.3

58.0

58.6

59.2

59.9

60.6

61.2

61.6

62.2

62.8

±S.D.

13.5

13.5

13.4

13.4

13.4

13.3

13.3

13.2

13.1

13.0

12.9

Mean age of the incident dialysis patients

59.8

60.4

61.0

61.5

62.2

62.7

63.4

63.8

64.2

64.7

65.4

±S.D.

14.4

14.3

14.2

14.2

14.0

13.9

13.9

13.9

13.7

13.6

13.5

 

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Mean age of the prevalent dialysis patients

63.3

63.9

64.4

64.9

65.3

65.8

66.2

66.6

66.9

67.2

67.5

±S.D.

12.9

12.8

12.8

12.7

12.7

12.6

12.6

12.6

12.5

12.5

12.5

Mean age of the incident dialysis patients

65.8

66.2

66.4

66.8

67.2

67.3

67.8

67.8

68.5

68.7

69.0

±S.D.

13.4

13.4

13.4

13.3

13.3

13.3

13.3

13.4

13.4

13.4

13.4

Table 6

Incident dialysis patient distribution by gender and age

Age at dialysis initiation

Male

Female

Subtotal

No information available

Total

<5

2

8

10

 

10

(%)

(0.0)

(0.1)

(0.0)

 

(0.0)

5~9

2

2

4

 

4

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

10~14

6

5

11

 

11

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

15~19

23

13

36

 

36

(%)

(0.1)

(0.1)

(0.1)

 

(0.1)

20~24

39

27

66

 

66

(%)

(0.2)

(0.2)

(0.2)

 

(0.2)

25~29

77

43

120

 

120

(%)

(0.3)

(0.4)

(0.3)

 

(0.3)

30~34

175

86

261

 

261

(%)

(0.7)

(0.7)

(0.7)

 

(0.7)

35~39

383

144

527

 

527

(%)

(1.6)

(1.2)

(1.4)

 

(1.4)

40~44

764

260

1024

 

1024

(%)

(3.1)

(2.2)

(2.8)

 

(2.8)

45~49

1052

370

1422

 

1422

(%)

(4.3)

(3.1)

(3.9)

 

(3.9)

50~54

1330

492

1822

 

1822

(%)

(5.4)

(4.2)

(5.0)

 

(5.0)

55~59

1770

680

2450

 

2450

(%)

(7.2)

(5.8)

(6.7)

 

(6.7)

60~64

2753

1045

3798

 

3798

(%)

(11.2)

(8.8)

(10.4)

 

(10.4)

65~69

3598

1471

5069

 

5069

(%)

(14.7)

(12.5)

(13.9)

 

(13.9)

70~74

3691

1687

5378

 

5378

(%)

(15.0)

(14.3)

(14.8)

 

(14.8)

75~79

3790

1895

5685

 

5685

(%)

(15.4)

(16.0)

(15.6)

 

(15.6)

80~84

3220

1934

5154

 

5154

(%)

(13.1)

(16.4)

(14.2)

 

(14.2)

85~89

1517

1291

2808

 

2808

(%)

(6.2)

(10.9)

(7.7)

 

(7.7)

90~94

318

318

636

 

636

(%)

(1.3)

(2.7)

(1.7)

 

(1.7)

95

41

42

83

 

83

(%)

(0.2)

(0.4)

(0.2)

 

(0.2)

Subtotal

24,551

11,813

36,364

 

36,364

(%)

(100.0)

(100.0)

(100.0)

 

(100.0)

Unknown

10

3

13

 

13

No information available

Total

24,561

11,816

36,377

 

36,377

Mean age

68.14

70.91

69.04

 

69.04

S.D.

13.20

13.60

13.39

 

13.39

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

Table 7

Prevalent dialysis patient distribution by gender and age

Age at the end of 2014

Male

Female

Subtotal

No information available

Total

<5

21

20

41

 

41

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

5~9

15

17

32

 

32

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

10~14

23

21

44

 

44

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

15~19

72

37

109

 

109

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

20~24

152

94

246

 

246

(%)

(0.1)

(0.1)

(0.1)

 

(0.1)

25~29

455

227

682

 

682

(%)

(0.2)

(0.2)

(0.2)

 

(0.2)

30~34

1165

599

1764

 

1764

(%)

(0.6)

(0.5)

(0.6)

 

(0.6)

35~39

2771

1254

4025

 

4025

(%)

(1.4)

(1.1)

(1.3)

 

(1.3)

40~44

5985

2611

8596

 

8596

(%)

(3.0)

(2.3)

(2.8)

 

(2.8)

45~49

9334

3971

13,305

 

13,305

(%)

(4.7)

(3.5)

(4.3)

 

(4.3)

50~54

12,319

5594

17,913

 

17,913

(%)

(6.2)

(5.0)

(5.8)

 

(5.8)

55~59

17,067

8283

25,350

 

25,350

(%)

(8.6)

(7.4)

(8.2)

 

(8.2)

60~64

26,673

13,679

40,352

 

40,352

(%)

(13.5)

(12.2)

(13.0)

 

(13.0)

65~69

34,272

17,987

52,259

 

52,259

(%)

(17.3)

(16.1)

(16.9)

 

(16.9)

70~74

31,614

17,753

49,367

 

49,367

(%)

(16.0)

(15.9)

(15.9)

 

(15.9)

75~79

26,319

15,932

42,251

 

42,251

(%)

(13.3)

(14.2)

(13.6)

 

(13.6)

80~84

18,970

13,117

32,087

 

32,087

(%)

(9.6)

(11.7)

(10.3)

 

(10.3)

85~89

8681

7978

16,659

 

16,659

(%)

(4.4)

(7.1)

(5.4)

 

(5.4)

90~94

1959

2428

4387

 

4387

(%)

(1.0)

(2.2)

(1.4)

 

(1.4)

95

258

360

618

 

618

(%)

(0.1)

(0.3)

(0.2)

 

(0.2)

Subtotal

198,125

111,962

310,087

 

310,087

(%)

(100.0)

(100.0)

(100.0)

 

(100.0)

Unknown

16

5

21

 

21

No information available

Total

198,141

111,967

310,108

 

310,108

Mean age

66.75

68.94

67.54

 

67.54

S.D.

12.36

12.60

12.49

 

12.49

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

Primary diseases

Three major primary diseases of end-stage kidney disease (ESKD) were diabetes, chronic glomerulonephritis, and nephrosclerosis. The three major and other primary diseases of ESKD were summarized by gender and age in the incident patients (Table 8) and in the prevalent patients (Table 9). Diabetes was the most frequent primary disease as 43.5%, followed by chronic glomerulonephritis as 17.8% (Table 10 upper panel). The number and percentage of diabetes of the cause of ESKD on the incident dialysis patients had been increased until the end of 2009 and reached 16,549 and 44.5%, respectively, in 2009 (Table 10 upper panel, Fig. 3 Left). However, they had stopped increasing and started decreasing since 2011. Annual increasing rates of chronic glomerulonephritis and diabetes after 2002 were plotted in Fig. 4. The increasing rates were collected by the responsive rate to the survey. The increasing rate of diabetes had been positive until 2009 but turned to be negative since 2012. It suggests that the number of the incident dialysis patients with diabetes is expected to gradually decrease continuously in the future. In contrast, the increasing rate of chronic glomerulonephritis had been negative for more than the recent 10 years, indicating that the number of the incident dialysis patients with chronic glomerulonephritis continued to decrease. Nephrosclerosis was the third most common primary disease (14.2%) after diabetes and chronic glomerulonephritis. In accordance with the aging of incident dialysis patients, the percentage of patients with nephrosclerosis continued to increase steadily. The percentage of patients with “unspecified” primary diseases was the fourth highest (11.3%). In addition, polycystic kidney disease (PKD), rapidly progressive glomerulonephritis (RPGN), lupus, and chronic pyelonephritis were also observed as primary diseases. However, the percentages of these primary diseases among the incident dialysis patients were 0.7–2.7%, which were much lower than the percentages of patients with the abovementioned top three primary diseases and unspecified diseases, and had shown no marked increase or decrease over the past 20 years.
Table 8

Incident dialysis patient distribution by age and primary disease

Primary disease

<5

5~9

10~14

15~19

20~24

25~29

30~34

35~39

40~44

45~49

50~54

55~59

60~64

65~69

70~74

75~79

80~84

85~89

90~94

95

Subtotal

Unspecified

No information on birth date

Total

Mean age

S.D.

Chronic glomerulonephritis

 

1

2

8

22

39

72

139

215

276

311

399

607

839

905

995

943

563

116

14

6466

  

6466

68.66

14.41

(%)

 

(25.0)

(18.2)

(22.2)

(33.3)

(32.5)

(27.6)

(26.4)

(21.0)

(19.4)

(17.1)

(16.3)

(16.0)

(16.6)

(16.8)

(17.5)

(18.3)

(20.0)

(18.2)

(16.9)

(17.8)

  

(17.8)

  

Chronic pyelonephritis

    

2

2

2

10

4

10

10

24

22

32

31

52

45

20

4

 

270

1

 

271

68.86

14.60

(%)

    

(3.0)

(1.7)

(0.8)

(1.9)

(0.4)

(0.7)

(0.5)

(1.0)

(0.6)

(0.6)

(0.6)

(0.9)

(0.9)

(0.7)

(0.6)

 

(0.7)

(7.7)

 

(0.7)

  

RPGN

 

1

  

3

2

2

3

5

12

14

14

46

57

87

105

98

55

15

 

519

  

519

72.86

12.46

(%)

 

(25.0)

  

(4.5)

(1.7)

(0.8)

(0.6)

(0.5)

(0.8)

(0.8)

(0.6)

(1.2)

(1.1)

(1.6)

(1.8)

(1.9)

(2.0)

(2.4)

 

(1.4)

  

(1.4)

  

PIH

      

1

1

2

3

1

9

1

5

7

7

3

2

  

42

  

42

64.81

14.13

(%)

      

(0.4)

(0.2)

(0.2)

(0.2)

(0.1)

(0.4)

(0.0)

(0.1)

(0.1)

(0.1)

(0.1)

(0.1)

  

(0.1)

  

(0.1)

  

Unclassified nephritis

1

 

3

3

5

4

1

4

8

5

5

12

14

13

21

21

12

10

4

 

146

  

146

62.36

20.36

(%)

(10.0)

 

(27.3)

(8.3)

(7.6)

(3.3)

(0.4)

(0.8)

(0.8)

(0.4)

(0.3)

(0.5)

(0.4)

(0.3)

(0.4)

(0.4)

(0.2)

(0.4)

(0.6)

 

(0.4)

  

(0.4)

  

PKD

   

1

2

3

6

16

50

88

108

122

148

125

118

88

74

41

8

1

999

  

999

63.05

13.11

(%)

   

(2.8)

(3.0)

(2.5)

(2.3)

(3.0)

(4.9)

(6.2)

(5.9)

(5.0)

(3.9)

(2.5)

(2.2)

(1.5)

(1.4)

(1.5)

(1.3)

(1.2)

(2.7)

  

(2.7)

  

Nephrosclerosis

  

1

3

4

11

13

19

68

82

110

172

292

513

758

985

1185

726

187

22

5151

  

5151

75.01

11.37

(%)

  

(9.1)

(8.3)

(6.1)

(9.2)

(5.0)

(3.6)

(6.6)

(5.8)

(6.0)

(7.0)

(7.7)

(10.1)

(14.1)

(17.3)

(23.0)

(25.9)

(29.4)

(26.5)

(14.2)

  

(14.2)

  

Hypertensive emergencies

     

2

11

20

18

17

24

17

29

26

33

41

46

24

7

 

315

  

315

64.95

16.72

(%)

     

(1.7)

(4.2)

(3.8)

(1.8)

(1.2)

(1.3)

(0.7)

(0.8)

(0.5)

(0.6)

(0.7)

(0.9)

(0.9)

(1.1)

 

(0.9)

  

(0.9)

  

Diabetes

   

2

2

9

77

194

472

733

977

1352

2094

2654

2483

2288

1640

701

121

10

15,809

  

15,809

67.16

12.03

(%)

   

(5.6)

(3.0)

(7.5)

(29.5)

(36.8)

(46.1)

(51.5)

(53.6)

(55.2)

(55.1)

(52.4)

(46.2)

(40.2)

(31.8)

(25.0)

(19.0)

(12.0)

(43.5)

  

(43.5)

  

Lupus

   

2

3

5

4

10

19

17

13

21

25

37

33

32

29

13

4

 

267

1

 

268

63.55

16.42

(%)

   

(5.6)

(4.5)

(4.2)

(1.5)

(1.9)

(1.9)

(1.2)

(0.7)

(0.9)

(0.7)

(0.7)

(0.6)

(0.6)

(0.6)

(0.5)

(0.6)

 

(0.7)

(7.7)

 

(0.7)

  

Amyloidosis

       

2

2

2

4

4

8

15

15

18

13

5

  

88

  

88

69.95

11.60

(%)

       

(0.4)

(0.2)

(0.1)

(0.2)

(0.2)

(0.2)

(0.3)

(0.3)

(0.3)

(0.3)

(0.2)

  

(0.2)

  

(0.2)

  

Gout

        

1

1

6

10

10

8

10

14

8

4

  

72

1

 

73

68.43

10.75

(%)

        

(0.1)

(0.1)

(0.3)

(0.4)

(0.3)

(0.2)

(0.2)

(0.2)

(0.2)

(0.1)

  

(0.2)

(7.7)

 

(0.2)

  

Inborn errors of metabolism

   

1

2

3

2

 

2

2

2

 

2

2

2

1

 

2

  

23

  

23

49.17

21.58

(%)

   

(2.8)

(3.0)

(2.5)

(0.8)

 

(0.2)

(0.1)

(0.1)

 

(0.1)

(0.0)

(0.0)

(0.0)

 

(0.1)

  

(0.1)

  

(0.1)

  

Tuberculosis

           

1

1

2

2

1

2

2

1

 

12

  

12

75.75

10.62

(%)

           

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

(0.1)

(0.2)

 

(0.0)

  

(0.0)

  

Urolithiasis

      

1

1

2

1

3

5

6

7

9

7

15

4

2

 

63

  

63

70.17

13.79

(%)

      

(0.4)

(0.2)

(0.2)

(0.1)

(0.2)

(0.2)

(0.2)

(0.1)

(0.2)

(0.1)

(0.3)

(0.1)

(0.3)

 

(0.2)

  

(0.2)

  

Neoplasm of kidney and urinary tract

   

1

   

1

2

2

4

6

12

31

36

32

33

12

6

 

178

  

178

72.91

10.90

(%)

   

(2.8)

   

(0.2)

(0.2)

(0.1)

(0.2)

(0.2)

(0.3)

(0.6)

(0.7)

(0.6)

(0.6)

(0.4)

(0.9)

 

(0.5)

  

(0.5)

  

Urinary tract obstructive

     

1

1

2

2

5

1

5

8

14

15

15

16

8

2

 

95

  

95

70.07

13.71

(%)

     

(0.8)

(0.4)

(0.4)

(0.2)

(0.4)

(0.1)

(0.2)

(0.2)

(0.3)

(0.3)

(0.3)

(0.3)

(0.3)

(0.3)

 

(0.3)

  

(0.3)

  

Myeloma

   

1

1

   

1

1

5

4

16

24

22

26

18

10

2

1

132

  

132

71.60

11.73

(%)

   

(2.8)

(1.5)

   

(0.1)

(0.1)

(0.3)

(0.2)

(0.4)

(0.5)

(0.4)

(0.5)

(0.3)

(0.4)

(0.3)

(1.2)

(0.4)

  

(0.4)

  

Hypoplastic kidney

4

1

2

7

4

5

9

5

2

1

 

2

4

5

2

2

4

 

1

 

60

  

60

39.82

24.64

(%)

(40.0)

(25.0)

(18.2)

(19.4)

(6.1)

(4.2)

(3.4)

(0.9)

(0.2)

(0.1)

 

(0.1)

(0.1)

(0.1)

(0.0)

(0.0)

(0.1)

 

(0.2)

 

(0.2)

  

(0.2)

  

Undetermined

1

 

1

3

7

16

30

62

98

101

151

177

313

469

568

724

726

498

117

30

4092

10

 

4102

72.04

13.52

(%)

(10.0)

 

(9.1)

(8.3)

(10.6)

(13.3)

(11.5)

(11.8)

(9.6)

(7.1)

(8.3)

(7.2)

(8.2)

(9.3)

(10.6)

(12.7)

(14.1)

(17.7)

(18.4)

(36.1)

(11.3)

(76.9)

 

(11.3)

  

Rejected kidney

    

3

6

12

9

14

18

26

27

16

24

14

14

14

4

3

 

204

  

204

57.60

16.13

(%)

    

(4.5)

(5.0)

(4.6)

(1.7)

(1.4)

(1.3)

(1.4)

(1.1)

(0.4)

(0.5)

(0.3)

(0.2)

(0.3)

(0.1)

(0.5)

 

(0.6)

  

(0.6)

  

Others

4

1

2

4

6

12

17

29

37

45

47

67

124

167

207

217

230

104

36

5

1361

  

1361

69.29

15.28

(%)

(40.0)

(25.0)

(18.2)

(11.1)

(9.1)

(10.0)

(6.5)

(5.5)

(3.6)

(3.2)

(2.6)

(2.7)

(3.3)

(3.3)

(3.8)

(3.8)

(4.5)

(3.7)

(5.7)

(6.0)

(3.7)

  

(3.7)

  

Subtotal

10

4

11

36

66

120

261

527

1024

1422

1822

2450

3798

5069

5378

5685

5154

2808

636

83

36,364

13

 

36,377

69.04

13.39

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

 

(100.0)

  

No information available

(%)

                          

Total

10

4

11

36

66

120

261

527

1024

1422

1822

2450

3798

5069

5378

5685

5154

2808

636

83

36,364

13

 

36,377

69.04

13.39

(%)

                          

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

The column “No information on birth date” shows the number of patients who provided no date of birth; thus, the calculation of age was impossible

RPGN Rapidly progressive glomerulonephritis, PIH Pregnancy-induced hypertension, PKD polycystic kidney disease

Table 9

Prevalent dialysis patient distribution by age and primary disease

Primary disease

<5

5~9

10~14

15~19

20~24

25~29

30~34

35~39

40~44

45~49

50~54

55~59

60~64

65~69

70~74

75~79

80~84

85~89

90~94

95

Subtotal

Unspecified

No information on birth date

Total

Mean age

S.D.

Chronic glomerulonephritis

1

4

6

28

71

242

647

1490

3009

4586

5996

8561

13,680

16,778

15,287

12,066

8773

4446

1139

160

96,970

  

96,970

66.54

12.47

(%)

(2.4)

(12.5)

(13.6)

(25.7)

(28.9)

(35.5)

(36.7)

(37.0)

(35.0)

(34.5)

(33.5)

(33.8)

(33.9)

(32.1)

(31.0)

(28.6)

(27.3)

(26.7)

(26.0)

(25.9)

(31.3)

  

(31.3)

  

Chronic pyelonephritis

   

1

6

19

35

90

133

170

191

251

353

494

466

372

261

150

42

7

3041

1

 

3042

65.46

13.88

(%)

   

(0.9)

(2.4)

(2.8)

(2.0)

(2.2)

(1.5)

(1.3)

(1.1)

(1.0)

(0.9)

(0.9)

(0.9)

(0.9)

(0.8)

(0.9)

(1.0)

(1.1)

(1.0)

(4.8)

 

(1.0)

  

RPGN

 

2

  

5

12

18

36

67

91

103

151

277

381

438

391

317

165

35

5

2494

  

2494

68.92

12.99

(%)

 

(6.3)

  

(2.0)

(1.8)

(1.0)

(0.9)

(0.8)

(0.7)

(0.6)

(0.6)

(0.7)

(0.7)

(0.9)

(0.9)

(1.0)

(1.0)

(0.8)

(0.8)

(0.8)

  

(0.8)

  

PIH

      

7

11

50

83

124

163

305

342

270

166

71

20

2

 

1614

  

1614

64.49

10.24

(%)

      

(0.4)

(0.3)

(0.6)

(0.6)

(0.7)

(0.6)

(0.8)

(0.7)

(0.5)

(0.4)

(0.2)

(0.1)

(0.0)

 

(0.5)

  

(0.5)

  

Unclassified nephritis

1

2

6

6

21

29

42

69

94

109

106

113

142

143

185

136

96

51

19

3

1373

  

1373

60.35

17.10

(%)

(2.4)

(6.3)

(13.6)

(5.5)

(8.5)

(4.3)

(2.4)

(1.7)

(1.1)

(0.8)

(0.6)

(0.4)

(0.4)

(0.3)

(0.4)

(0.3)

(0.3)

(0.3)

(0.4)

(0.5)

(0.4)

  

(0.4)

  

PKD

5

2

 

3

6

12

30

94

288

576

930

1274

1891

1980

1640

1177

727

299

62

10

11,006

  

11,006

65.01

11.29

(%)

(12.2)

(6.3)

 

(2.8)

(2.4)

(1.8)

(1.7)

(2.3)

(3.4)

(4.3)

(5.2)

(5.0)

(4.7)

(3.8)

(3.3)

(2.8)

(2.3)

(1.8)

(1.4)

(1.6)

(3.5)

  

(3.5)

  

Nephrosclerosis

  

2

2

12

29

60

144

389

611

745

1209

2092

3258

4221

5003

5469

3625

1244

182

28,297

1

 

28,298

73.99

11.76

(%)

  

(4.5)

(1.8)

(4.9)

(4.3)

(3.4)

(3.6)

(4.5)

(4.6)

(4.2)

(4.8)

(5.2)

(6.2)

(8.6)

(11.8)

(17.0)

(21.8)

(28.4)

(29.4)

(9.1)

(4.8)

 

(9.1)

  

Hypertensive emergencies

    

3

9

44

94

150

188

217

220

294

332

305

272

250

143

43

9

2573

  

2573

64.20

14.83

(%)

    

(1.2)

(1.3)

(2.5)

(2.3)

(1.7)

(1.4)

(1.2)

(0.9)

(0.7)

(0.6)

(0.6)

(0.6)

(0.8)

(0.9)

(1.0)

(1.5)

(0.8)

  

(0.8)

  

Diabetes

2

1

2

8

7

35

313

1048

2859

4831

7042

10,197

16,451

22,304

20,127

16,494

10,789

4570

901

98

118,079

2

 

118,081

67.33

11.28

(%)

(4.9)

(3.1)

(4.5)

(7.3)

(2.8)

(5.1)

(17.7)

(26.0)

(33.3)

(36.3)

(39.3)

(40.2)

(40.8)

(42.7)

(40.8)

(39.0)

(33.6)

(27.4)

(20.5)

(15.9)

(38.1)

(9.5)

 

(38.1)

  

Lupus

  

1

5

9

24

41

80

138

207

214

261

298

324

244

202

116

61

10

1

2236

  

2236

60.73

13.97

(%)

  

(2.3)

(4.6)

(3.7)

(3.5)

(2.3)

(2.0)

(1.6)

(1.6)

(1.2)

(1.0)

(0.7)

(0.6)

(0.5)

(0.5)

(0.4)

(0.4)

(0.2)

(0.2)

(0.7)

  

(0.7)

  

Amyloidosis

       

4

19

19

27

27

56

77

86

70

47

15

4

 

451

  

451

67.50

11.65

(%)

       

(0.1)

(0.2)

(0.1)

(0.2)

(0.1)

(0.1)

(0.1)

(0.2)

(0.2)

(0.1)

(0.1)

(0.1)

 

(0.1)

  

(0.1)

  

Gout

     

1

3

8

29

40

68

82

152

201

207

181

96

39

4

1

1112

1

 

1113

67.56

11.06

(%)

     

(0.1)

(0.2)

(0.2)

(0.3)

(0.3)

(0.4)

(0.3)

(0.4)

(0.4)

(0.4)

(0.4)

(0.3)

(0.2)

(0.1)

(0.2)

(0.4)

(4.8)

 

(0.4)

  

Inborn errors of metabolism

2

  

5

10

17

19

29

39

30

17

23

27

23

13

7

4

7

  

272

  

272

48.99

16.94

(%)

(4.9)

  

(4.6)

(4.1)

(2.5)

(1.1)

(0.7)

(0.5)

(0.2)

(0.1)

(0.1)

(0.1)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

  

(0.1)

  

(0.1)

  

Tuberculosis

         

1

4

9

19

47

54

20

37

10

5

 

206

  

206

72.33

8.75

(%)

         

(0.0)

(0.0)

(0.0)

(0.0)

(0.1)

(0.1)

(0.0)

(0.1)

(0.1)

(0.1)

 

(0.1)

  

(0.1)

  

Urolithiasis

      

1

3

8

11

26

44

60

97

103

94

85

38

10

1

581

  

581

70.48

11.08

(%)

      

(0.1)

(0.1)

(0.1)

(0.1)

(0.1)

(0.2)

(0.1)

(0.2)

(0.2)

(0.2)

(0.3)

(0.2)

(0.2)

(0.2)

(0.2)

  

(0.2)

  

Neoplasm of kidney and urinary tract

   

1

 

1

3

7

7

11

19

39

76

139

173

154

174

62

17

3

886

  

886

72.53

10.68

(%)

   

(0.9)

 

(0.1)

(0.2)

(0.2)

(0.1)

(0.1)

(0.1)

(0.2)

(0.2)

(0.3)

(0.4)

(0.4)

(0.5)

(0.4)

(0.4)

(0.5)

(0.3)

  

(0.3)

  

Urinary tract obstructive

1

 

1

 

3

9

27

42

41

43

42

32

66

90

102

89

88

36

10

 

722

1

 

723

63.81

16.72

(%)

(2.4)

 

(2.3)

 

(1.2)

(1.3)

(1.5)

(1.0)

(0.5)

(0.3)

(0.2)

(0.1)

(0.2)

(0.2)

(0.2)

(0.2)

(0.3)

(0.2)

(0.2)

 

(0.2)

(4.8)

 

(0.2)

  

Myeloma

   

2

  

1

1

6

6

10

12

29

51

50

43

38

22

2

3

276

  

276

70.55

12.17

(%)

   

(1.8)

  

(0.1)

(0.0)

(0.1)

(0.0)

(0.1)

(0.0)

(0.1)

(0.1)

(0.1)

(0.1)

(0.1)

(0.1)

(0.0)

(0.5)

(0.1)

  

(0.1)

  

Hypoplastic kidney

10

11

13

21

29

47

71

94

72

67

38

29

30

34

32

26

15

6

4

 

649

  

649

44.24

19.08

(%)

(24.4)

(34.4)

(29.5)

(19.3)

(11.8)

(6.9)

(4.0)

(2.3)

(0.8)

(0.5)

(0.2)

(0.1)

(0.1)

(0.1)

(0.1)

(0.1)

(0.0)

(0.0)

(0.1)

 

(0.2)

  

(0.2)

  

Undetermined

2

 

2

11

23

69

185

382

712

992

1236

1757

2937

3907

4152

4201

3732

2418

698

114

27,530

14

 

27,544

69.80

13.13

(%)

(4.9)

 

(4.5)

(10.1)

(9.3)

(10.1)

(10.5)

(9.5)

(8.3)

(7.5)

(6.9)

(6.9)

(7.3)

(7.5)

(8.4)

(9.9)

(11.6)

(14.5)

(15.9)

(18.4)

(8.9)

(66.7)

 

(8.9)

  

Rejected kidney

  

2

1

12

22

64

91

181

240

315

367

332

257

115

73

58

22

10

1

2163

  

2163

56.37

12.59

(%)

  

(4.5)

(0.9)

(4.9)

(3.2)

(3.6)

(2.3)

(2.1)

(1.8)

(1.8)

(1.4)

(0.8)

(0.5)

(0.2)

(0.2)

(0.2)

(0.1)

(0.2)

(0.2)

(0.7)

  

(0.7)

  

Others

17

10

9

15

29

105

153

208

305

393

443

529

785

1000

1097

1014

844

454

126

20

7556

1

 

7557

65.60

15.70

(%)

(41.5)

(31.3)

(20.5)

(13.8)

(11.8)

(15.4)

(8.7)

(5.2)

(3.5)

(3.0)

(2.5)

(2.1)

(1.9)

(1.9)

(2.2)

(2.4)

(2.6)

(2.7)

(2.9)

(3.2)

(2.4)

(4.8)

 

(2.4)

  

Subtotal

41

32

44

109

246

682

1764

4025

8596

13,305

17,913

25,350

40,352

52,259

49,367

42,251

32,087

16,659

4387

618

310,087

21

 

310,108

67.54

12.49

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

 

(100.0)

  

No information available

(%)

                          

Total

41

32

44

109

246

682

1764

4025

8596

13,305

17,913

25,350

40,352

52,259

49,367

42,251

32,087

16,659

4387

618

310,087

21

 

310,108

67.54

12.49

(%)

                          

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

The column “No information on birth date” shows the number of patients who provided no date of birth; thus, the calculation of age was impossible

RPGN Rapidly progressive glomerulonephritis, PIH Pregnancy-induced hypertension, PKD polycystic kidney disease

Table 10

Annual changes of primary disease in the incident and prevalent dialysis patients

Incident patients

           
 

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Diabetes

29.9

30.7

31.9

33.1

33.9

35.7

36.2

36.6

38.1

39.1

41.0

Chronic glomerulonephritis

41.4

40.5

39.4

38.9

36.6

35.0

33.6

32.5

32.4

31.9

29.1

Nephrosclerosis

6.2

6.1

6.3

6.4

6.8

6.7

7.0

7.6

7.6

7.8

8.5

PKD

2.6

2.5

2.4

2.5

2.4

2.4

2.2

2.4

2.3

2.4

2.3

RPGN

0.8

0.8

0.8

0.8

1.1

0.9

0.9

1.0

1.0

1.1

1.2

Lupus

1.2

1.2

1.1

1.3

1.0

1.1

1.2

0.9

1.0

0.9

0.7

Chronic pyelonephritis

1.1

1.4

1.2

1.1

1.2

1.1

1.1

1.0

1.1

0.9

1.0

Undetermined

3.3

3.9

4.5

5.0

5.5

5.6

6.1

7.6

9.0

8.4

8.8

 

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Diabetes

41.3

42.0

42.9

43.4

43.3

44.5

43.6

44.3

44.2

43.8

43.5

Chronic glomerulonephritis

28.1

27.4

25.6

23.8

22.8

21.9

21.0

20.2

19.4

18.8

17.8

Nephrosclerosis

8.8

9.0

9.4

10.0

10.6

10.7

11.7

11.8

12.3

13.1

14.2

PKD

2.7

2.3

2.4

2.3

2.5

2.3

2.4

2.5

2.5

2.5

2.7

RPGN

1.1

1.1

1.2

1.3

1.2

1.2

1.2

1.3

1.3

1.4

1.4

Lupus

0.8

0.8

0.8

0.8

0.8

0.7

0.8

0.7

0.7

0.7

0.7

Chronic pyelonephritis

0.9

1.0

0.8

0.8

0.7

0.7

0.8

0.7

0.8

0.8

0.7

Undetermined

9.3

9.5

9.9

10.2

10.6

10.7

10.7

10.9

11.0

11.3

11.3

Prevalent patients

 

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Diabetes

18.2

19.2

20.4

21.6

22.7

24.0

25.1

26.0

27.2

28.1

29.2

Chronic glomerulonephritis

58.8

57.7

56.6

55.4

54.1

52.5

51.1

49.7

49.6

48.2

46.6

Nephrosclerosis

3.4

3.6

3.8

4.0

4.2

4.4

4.5

4.8

5.0

5.1

5.3

PKD

3.3

3.2

3.2

3.2

3.2

3.2

3.2

3.2

3.3

3.3

3.3

RPGN

1.9

1.8

1.7

1.6

1.6

1.5

1.5

1.4

1.4

1.3

1.3

Lupus

1.1

1.1

1.1

1.1

1.1

1.1

1.1

1.0

1.0

1.0

0.9

Chronic pyelonephritis

0.5

0.5

0.5

0.5

0.6

0.6

0.6

0.6

0.6

0.6

0.6

Undetermined

2.9

3.1

3.2

3.6

3.9

4.2

4.4

5.0

5.6

5.9

6.3

 

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Diabetes

30.2

31.4

32.3

33.4

34.2

35.1

35.9

36.7

37.1

37.6

38.1

Chronic glomerulonephritis

45.1

43.6

42.2

40.4

39.0

37.6

36.2

34.8

33.6

32.4

31.3

Nephrosclerosis

5.7

5.9

6.2

6.5

6.8

7.1

7.5

7.9

8.3

8.7

9.1

PKD

3.4

3.3

3.4

3.4

3.4

3.4

3.4

3.4

3.4

3.5

3.5

RPGN

1.3

1.2

1.2

1.2

1.1

1.1

1.1

1.0

1.0

1.0

1.0

Lupus

0.9

0.9

0.9

0.9

0.8

0.8

0.8

0.8

0.8

0.7

0.7

Chronic pyelonephritis

0.6

0.6

0.6

0.7

0.7

0.7

0.7

0.7

0.8

0.8

0.8

Undetermined

6.4

6.6

7.0

7.4

7.6

7.7

8.0

8.2

8.5

8.7

8.9

PKD polycystic kidney disease, RPGN rapidly progressive glomerulonephritis

Fig. 3
Fig. 3

Annual changes in the distributions of three major primary diseases in the incident patients (left) and the prevalent patients (right)

Fig. 4
Fig. 4

Annual increasing rates of incident dialysis patients from diabetes and chronic glomerulonephritis

Chronic glomerulonephritis was the most common primary disease in the prevalent dialysis patients but the percentage of chronic glomerulonephritis has been decreasing. In contrast, the percentage of diabetes has been increasing and it has been the most common primary disease in the prevalent dialysis patients since 2011. (Table 10 lower panel, Fig. 3 Right) In 2014, the percentage of diabetes further increased (38.1%), whereas that of chronic glomerulonephritis further decreased (31.3%). Nephrosclerosis was the third highest percentage of primary disease in the prevalent dialysis patients in 2014 (9.1%). The percentage of nephrosclerosis has been increasing. The percentage of patients with “unspecified” primary diseases was the fourth highest (8.9%). In addition, polycystic kidney disease, chronic pyelonephritis, lupus, and RPGN were also observed as primary diseases. However, the percentages of these primary diseases were only 0.7–3.5% and had shown no marked increase or decrease over the past 20 years.

Causes of death

The causes of death in the incident dialysis patients in 2014 were summarized in Table 11. The leading cause of death of them was infectious diseases (25.8%), followed by cardiac failure (23.8%), malignant tumors (11.4%), other causes (11.2%), and unspecified causes (7.8%). The causes of death in the prevalent dialysis patients in 2014 were summarized in Table 12. Table 13 shows annual changes in the percentages of the leading causes of death in prevalent dialysis patients. Among the prevalent dialysis patients, the leading cause of death in 2014 was cardiac failure (26.3%). The percentage of cardiac failure in prevalent dialysis patients had markedly decreased by the early 1990s, and it has remained almost unchanged. The second leading cause of death was infectious diseases (20.9%); the percentage of it had been increasing by 2009, and it has remained almost unchanged. The percentage of malignant tumors was 9.0%. The percentage cerebrovascular disease had continued to decrease since 1995 and was 7.1% in 2014. The percentage of myocardial infarction was 4.3% in 2014.
Table 11

Causes of death in incident dialysis patients

Cause of death

Male

Female

Subtotal

No information available

Total

Heart failure

335

212

547

 

547

(%)

(22.8)

(25.5)

(23.8)

 

(23.8)

Cerebrovascular disorder

67

37

104

 

104

(%)

(4.6)

(4.5)

(4.5)

 

(4.5)

Infectious disease

386

206

592

 

592

(%)

(26.3)

(24.8)

(25.8)

 

(25.8)

Hemorrhage

31

21

52

 

52

(%)

(2.1)

(2.5)

(2.3)

 

(2.3)

Malignant tumors

186

77

263

 

263

(%)

(12.7)

(9.3)

(11.4)

 

(11.4)

Cachexia/Uremia

60

39

99

 

99

(%)

(4.1)

(4.7)

(4.3)

 

(4.3)

Cardiac infarction

46

29

75

 

75

(%)

(3.1)

(3.5)

(3.3)

 

(3.3)

Potassium poisoning/Sudden death

23

15

38

 

38

(%)

(1.6)

(1.8)

(1.7)

 

(1.7)

Chronic hepatitis/Cirrhosis

15

10

25

 

25

(%)

(1.0)

(1.2)

(1.1)

 

(1.1)

Suicide/Refusal of treatment (dialysis)

18

3

21

 

21

(%)

(1.2)

(0.4)

(0.9)

 

(0.9)

Intestinal obstruction

14

11

25

 

25

(%)

(1.0)

(1.3)

(1.1)

 

(1.1)

Pulmonary thrombus/Pulmonary embolus

8

1

9

 

9

(%)

(0.5)

(0.1)

(0.4)

 

(0.4)

Death due to disaster

8

3

11

 

11

(%)

(0.5)

(0.4)

(0.5)

 

(0.5)

Other causes

156

102

258

 

258

(%)

(10.6)

(12.3)

(11.2)

 

(11.2)

Unspecified

115

65

180

 

180

(%)

(7.8)

(7.8)

(7.8)

 

(7.8)

Subtotal

1468

831

2299

 

2299

(%)

(100.0)

(100.0)

(100.0)

 

(100.0)

No information available

Total

1468

831

2299

 

2299

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

Table 12

Causes of deaths in prevalent dialysis patients

Cause of death

Male

Female

Subtotal

No information available

Total

Heart failure

4800

2975

7775

 

7775

(%)

(25.2)

(28.3)

(26.3)

 

(26.3)

Cerebrovascular disorder

1329

769

2098

 

2098

(%)

(7.0)

(7.3)

(7.1)

 

(7.1)

Infectious disease

4066

2096

6162

 

6162

(%)

(21.4)

(20.0)

(20.9)

 

(20.9)

Hemorrhage

280

191

471

 

471

(%)

(1.5)

(1.8)

(1.6)

 

(1.6)

Malignant tumors

1951

718

2669

 

2669

(%)

(10.3)

(6.8)

(9.0)

 

(9.0)

Cachexia/Uremia

652

518

1170

 

1170

(%)

(3.4)

(4.9)

(4.0)

 

(4.0)

Cardiac infarction

868

390

1258

 

1258

(%)

(4.6)

(3.7)

(4.3)

 

(4.3)

Potassium poisoning/Sudden death

551

243

794

 

794

(%)

(2.9)

(2.3)

(2.7)

 

(2.7)

Chronic hepatitis/Cirrhosis

206

72

278

 

278

(%)

(1.1)

(0.7)

(0.9)

 

(0.9)

Suicide/Refusal of treatment (dialysis)

166

49

215

 

215

(%)

(0.9)

(0.5)

(0.7)

 

(0.7)

Intestinal obstruction

181

129

310

 

310

(%)

(1.0)

(1.2)

(1.0)

 

(1.0)

Pulmonary thrombus/Pulmonary embolus

55

24

79

 

79

(%)

(0.3)

(0.2)

(0.3)

 

(0.3)

Death due to disaster

112

45

157

 

157

(%)

(0.6)

(0.4)

(0.5)

 

(0.5)

Other causes

1603

1147

2750

 

2750

(%)

(8.4)

(10.9)

(9.3)

 

(9.3)

Unspecified

2209

1130

3339

 

3339

(%)

(11.6)

(10.8)

(11.3)

 

(11.3)

Subtotal

19,029

10,496

29,525

 

29,525

(%)

(100.0)

(100.0)

(100.0)

 

(100.0)

No information available

     

Total

19,029

10,496

29,525

 

29,525

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

Table 13

Annual changes in major causes of death

Cause of death

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Cardiac failure

29.9

28.2

25.4

24.1

23.9

24.1

24.3

23.2

25.5

25.1

25.0

Infectious disease

12.2

12.6

13.8

14.6

14.9

15.0

16.3

16.6

16.3

15.9

18.5

Malignant tumor

7.4

7.3

7.2

7.7

8.1

7.7

7.6

8.3

8.5

8.5

8.5

Cerebrovascular disease

13.5

14.1

13.5

12.9

12.6

12.1

11.3

11.3

11.6

11.2

10.7

Cardiac infarction

5.7

7.1

7.5

7.4

8.4

7.9

7.4

7.0

7.4

7.4

6.2

Others

4.1

4.5

5.8

6.3

6.7

7.0

7.7

7.9

9.1

9.0

9.7

Unspecified

2.6

2.8

3.2

2.5

3.5

3.9

3.6

8.1

5.7

6.6

5.6

Cause of death

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Cardiac failure

25.1

25.8

24.9

24.0

23.7

23.6

27.0

26.6

27.2

26.8

26.3

Infectious disease

18.8

19.2

19.9

18.9

19.9

20.7

20.3

20.3

20.4

20.8

20.9

Malignant tumor

9.0

9.0

9.2

9.2

9.2

9.4

9.8

9.1

9.1

9.4

9.0

Cerebrovascular disease

10.6

9.8

9.4

8.9

8.6

8.4

8.1

7.7

7.5

7.2

7.1

Cardiac infarction

5.4

5.1

4.4

4.4

4.1

4.0

4.7

4.6

4.5

4.3

4.3

Others

10.3

9.1

9.5

9.7

9.7

10.0

6.6

8.4

8.5

8.8

9.3

Unspecified

6.5

7.3

8.3

10.3

10.9

10.6

10.9

10.8

10.5

10.8

11.3

The classification codes for the causes of death were revised in the 2003 and 2010 surveys. We speculate that these revisions might have had some influence on the distributions of causes of death. These revisions were detailed in the annual data report 2010 [6].

Annual crude death rate

The annual crude death rate was calculated from the facility survey data as shown in Table 14. The annual crude death rate is defined as the percentage of patients who died each year with respect to the mean annual dialysis patient counts. Table 14 shows the annual crude death rates between 1993 and 2014. It had remained in the range of 9.0–9.9% until 2010 but was in the range of 10.0–10.9% in 2011 and 2012. However, it was again in the range of 9.0–9.9% (9.8% in 2013 and 9.7% in 2014).
Table 14

Annual crude death rate

Year

Crude death rate (%)

Year

Crude death rate (%)

1993

9.4

2004

9.4

1994

9.5

2005

9.5

1995

9.7

2006

9.2

1996

9.4

2007

9.4

1997

9.4

2008

9.8

1998

9.2

2009

9.6

1999

9.7

2010

9.8

2000

9.2

2011

10.2

2001

9.3

2012

10.0

2002

9.2

2013

9.8

2003

9.3

2014

9.7

Cumulative survival rate of incident dialysis patients since 1983

The cumulative survival rates of the incident dialysis patients by the year of starting dialysis since 1983 are summarized in Table 15. The 1- to 10-year survival rates were the lowest for patients who started dialysis in 1992 and were increasing in patients in 1993 or later. However, the 5-year survival rate for patients who started dialysis between 2003 and 2009 and the 10-year survival rate for between 1998 and 2004 remained almost unchanged. The 20- or more year survival rates tended to decrease.
Table 15

Cumulative survival rates by incident year since 1983

Year of introduction

Number of patients

1-year survival rate

2-year survival rate

3-year survival rate

4-year survival rate

5-year survival rate

6-year survival rate

7-year survival rate

8-year survival rate

9-year survival rate

10-year survival rate

11-year survival rate

12-year survival rate

13-year survival rate

14-year survival rate

15-year survival rate

16-year survival rate

17-year survival rate

18-year survival rate

19-year survival rate

20-year survival rate

21-year survival rate

22-year survival rate

23-year survival rate

24-year survival rate

25-year survival rate

26-year survival rate

27-year survival rate

28-year survival rate

29-year survival rate

30-year survival rate

31-year survival rate

1983

9856

0.818

0.747

0.680

0.630

0.585

0.552

0.519

0.480

0.450

0.419

0.389

0.365

0.342

0.322

0.301

0.282

0.265

0.249

0.235

0.222

0.207

0.193

0.182

0.173

0.162

0.151

0.142

0.131

0.120

0.110

0.103

1984

10,687

0.816

0.735

0.670

0.619

0.576

0.536

0.495

0.461

0.430

0.402

0.373

0.348

0.323

0.302

0.282

0.264

0.247

0.233

0.221

0.207

0.194

0.183

0.174

0.162

0.153

0.144

0.135

0.125

0.117

0.108

 

1985

11,582

0.794

0.720

0.659

0.607

0.561

0.517

0.481

0.440

0.409

0.380

0.355

0.330

0.307

0.284

0.266

0.248

0.231

0.216

0.202

0.187

0.174

0.163

0.151

0.142

0.133

0.124

0.116

0.106

0.099

  

1986

12,585

0.798

0.724

0.665

0.616

0.563

0.516

0.474

0.439

0.402

0.373

0.345

0.321

0.299

0.278

0.261

0.244

0.228

0.215

0.203

0.191

0.178

0.168

0.157

0.148

0.139

0.130

0.120

0.110

   

1987

13,510

0.814

0.737

0.669

0.605

0.552

0.502

0.457

0.418

0.385

0.357

0.331

0.306

0.286

0.264

0.245

0.230

0.213

0.197

0.184

0.175

0.164

0.154

0.143

0.134

0.125

0.117

0.109

    

1988

14,719

0.824

0.739

0.664

0.599

0.541

0.493

0.450

0.412

0.377

0.346

0.319

0.296

0.274

0.252

0.234

0.218

0.203

0.190

0.180

0.168

0.157

0.147

0.138

0.129

0.121

0.111

     

1989

14,505

0.848

0.760

0.684

0.613

0.555

0.506

0.460

0.421

0.384

0.352

0.326

0.300

0.279

0.258

0.241

0.225

0.210

0.195

0.184

0.171

0.159

0.149

0.140

0.130

0.121

      

1990

16,495

0.838

0.748

0.672

0.606

0.551

0.497

0.454

0.413

0.379

0.348

0.320

0.295

0.274

0.255

0.238

0.222

0.207

0.193

0.181

0.169

0.157

0.145

0.136

0.127

       

1991

18,151

0.827

0.734

0.660

0.595

0.535

0.484

0.440

0.402

0.370

0.340

0.313

0.289

0.268

0.249

0.231

0.217

0.202

0.189

0.177

0.165

0.154

0.144

0.134

        

1992

19,837

0.820

0.727

0.650

0.585

0.527

0.479

0.434

0.396

0.363

0.335

0.309

0.285

0.265

0.245

0.228

0.212

0.198

0.184

0.171

0.158

0.146

0.136

         

1993

20,814

0.832

0.742

0.666

0.596

0.540

0.489

0.444

0.406

0.373

0.342

0.316

0.291

0.267

0.249

0.232

0.215

0.199

0.185

0.172

0.160

0.150

          

1994

21,307

0.829

0.742

0.668

0.602

0.542

0.488

0.445

0.407

0.372

0.340

0.311

0.288

0.267

0.246

0.227

0.211

0.197

0.184

0.171

0.159

           

1995

22,796

0.840

0.753

0.678

0.608

0.549

0.500

0.456

0.416

0.381

0.349

0.319

0.295

0.272

0.249

0.228

0.209

0.194

0.179

0.167

            

1996

24,830

0.831

0.749

0.672

0.607

0.553

0.505

0.454

0.416

0.380

0.348

0.319

0.292

0.267

0.247

0.228

0.209

0.193

0.180

             

1997

25,391

0.837

0.751

0.680

0.619

0.562

0.511

0.465

0.422

0.385

0.351

0.322

0.294

0.270

0.249

0.228

0.210

0.193

              

1998

26,697

0.844

0.765

0.697

0.634

0.573

0.522

0.473

0.431

0.395

0.362

0.332

0.304

0.278

0.256

0.235

0.217

               

1999

27,631

0.850

0.773

0.705

0.639

0.579

0.527

0.480

0.439

0.399

0.362

0.330

0.300

0.272

0.250

0.231

                

2000

29,125

0.855

0.777

0.711

0.647

0.588

0.533

0.487

0.443

0.403

0.367

0.333

0.305

0.280

0.256

                 

2001

30,660

0.854

0.777

0.707

0.641

0.585

0.532

0.484

0.441

0.401

0.364

0.330

0.299

0.272

                  

2002

31,333

0.857

0.780

0.712

0.649

0.589

0.533

0.484

0.439

0.397

0.359

0.327

0.298

                   

2003

32,358

0.859

0.785

0.716

0.653

0.594

0.538

0.490

0.441

0.399

0.362

0.331

                    

2004

33,458

0.865

0.790

0.723

0.660

0.600

0.544

0.492

0.445

0.401

0.362

                     

2005

34,534

0.861

0.789

0.721

0.656

0.596

0.538

0.484

0.437

0.396

                      

2006

35,960

0.870

0.798

0.729

0.666

0.604

0.546

0.493

0.448

                       

2007

36,711

0.866

0.794

0.725

0.658

0.594

0.537

0.487

                        

2008

37,787

0.866

0.796

0.727

0.660

0.597

0.542

                         

2009

38,313

0.872

0.797

0.727

0.662

0.605

                          

2010

38,213

0.876

0.803

0.732

0.669

                           

2011

37,946

0.872

0.797

0.729

                            

2012

36,278

0.891

0.828

                             

2013

36,369

0.897

                              

Chapter 2: Current status of microbiological quality of dialysis fluid and its control

Measurement of endotoxin concentration in dialysis fluid

Among 4304 facilities that had at least one bedside console, 4229 facilities (98.3%) responded to the question about the frequency for measuring endotoxin. The JSDT standard [7] for microbiological quality of dialysis fluid recommends that the endotoxin concentration in dialysis fluid should be measured at least once a month. The percentage of the facilities that satisfied this recommendation was 78.7%, a slight increase from the previous year as 77.7% (Table 16).
Table 16

Facility distribution on ET measurement by frequency and concentration

Endotoxin concentration in dialysis fluid (EU/ml)

Every day

Every week

Every 2 weeks

Every month

Several times per year

Once a year

None

Subtotal

Unspecified

No information available

Total

<0.001

20

131

205

2295

280

233

1

3165

2

 

3167

(%)

(0.6)

(4.1)

(6.5)

(72.5)

(8.8)

(7.4)

(0.0)

(100.0)

   

0.001, <0.01

5

22

27

371

75

46

 

546

2

 

548

(%)

(0.9)

(4.0)

(4.9)

(67.9)

(13.7)

(8.4)

 

(100.0)

   

0.01, <0.05

1

9

10

123

37

31

 

211

  

211

(%)

(0.5)

(4.3)

(4.7)

(58.3)

(17.5)

(14.7)

 

(100.0)

   

0.05, <0.1

 

1

2

39

12

9

 

63

  

63

(%)

 

(1.6)

(3.2)

(61.9)

(19.0)

(14.3)

 

(100.0)

   

0.1, <0.25

 

1

5

26

9

7

 

48

  

48

(%)

 

(2.1)

(10.4)

(54.2)

(18.8)

(14.6)

 

(100.0)

   

0.25, <0.5

  

1

11

2

6

 

20

  

20

(%)

  

(5.0)

(55.0)

(10.0)

(30.0)

 

(100.0)

   

0.5

1

 

2

15

1

3

 

22

  

22

(%)

(4.5)

 

(9.1)

(68.2)

(4.5)

(13.6)

 

(100.0)

   

Subtotal

27

164

252

2880

416

335

1

4075

4

 

4079

(%)

(0.7)

(4.0)

(6.2)

(70.7)

(10.2)

(8.2)

(0.0)

(100.0)

   

Unspecified

 

1

1

4

5

11

79

22

63

 

164

(%)

 

(1.0)

(1.0)

(4.0)

(5.0)

(10.9)

(78.2)

(100.0)

   

No information available

      

53

 

2

6

61

(%)

      

(100.0)

(100.0)

   

Total

27

165

253

2884

421

346

133

4229

69

6

4304

(%)

(0.6)

(3.9)

(6.0)

(68.2)

(10.0)

(8.2)

(3.1)

(100.0)

   

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

Four thousand seventy-nine facilities (94.8%) responded to the question about the endotoxin concentration. According to the standard, ultrapure dialysis fluid (UPD) defined as endotoxin <0.001 EU/mL and total viable microbial count (TVC) <0.1 cfu/mL is recommended for all dialysis modalities; and standard dialysis fluid defined as endotoxin <0.05 EU/mL and TVC <100 cfu/mL is the minimum desirable quality to ensure the safety of dialysis therapy [7]. Endotoxin concentration of <0.001 and <0.05 EU/mL were achieved in 77.6 and 96.2% of the 4079 facilities, respectively. These percentages were higher than those in the previous year as 73.9 and 95.1%, respectively (Table 16).

Measurement of TVC in dialysis fluid

Four thousand twenty-seven (97.7%) among all 4304 facilities responded to the question about the frequency of measurement of TVC. The JSDT standard [7] recommends that the TVC in dialysis fluid should be measured at least once a month. The percentage of the facilities that satisfied this recommendation was 74.8% as similar as 74.7% in 2013 (Table 17).
Table 17

Facility distribution on microbial measurement by frequency and TVC

TVC (cfu/mL)

Every day

Every week

Every 2 weeks

Every month

Several times per year

Once a year

None

Subtotal

Unspecified

No information available

Total

<0.1

11

100

185

1962

273

273

1

2805

6

 

2811

(%)

(0.4)

(3.6)

(6.6)

(69.9)

(9.7)

(9.7)

(0.0)

(100.0)

   

0.1, <1

 

18

40

364

68

60

 

550

1

 

551

(%)

 

(3.3)

(7.3)

(66.2)

(12.4)

(10.9)

 

(100.0)

   

1, <10

3

6

23

267

44

29

 

372

  

372

(%)

(0.8)

(1.6)

(6.2)

(71.8)

(11.8)

(7.8)

 

(100.0)

   

10, <100

1

1

5

111

20

17

1

156

  

156

(%)

(0.6)

(0.6)

(3.2)

(71.2)

(12.8)

(10.9)

(0.6)

(100.0)

   

100

1

2

1

22

9

5

 

40

  

40

(%)

(2.5)

(5.0)

(2.5)

(55.0)

(22.5)

(12.5)

 

(100.0)

   

Subtotal

16

127

254

2726

414

384

2

3923

7

 

3930

(%)

(0.4)

(3.2)

(6.5)

(69.5)

(10.6)

(9.8)

(0.1)

(100.0)

   

Unspecified

 

1

6

18

8

11

141

185

79

 

264

(%)

 

(0.5)

(3.2)

(9.7)

(4.3)

(5.9)

(76.2)

(100.0)

   

No information available

      

99

99

4

7

110

(%)

      

(100.0)

(100.0)

   

Total

16

128

260

2744

422

395

242

4207

90

7

4304

(%)

(0.4)

(3.0)

(6.2)

(65.2)

(10.0)

(9.4)

(5.8)

(100.0)

   

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

TVC total viable microbial count

Three thousand nine hundred thirty facilities (91.3%) responded to the question about the TVC in dialysis fluid. As previously addressed, JSDT guideline defined two qualities on TVC: UPD as <0.1 cfu/mL and the standard dialysis fluid as 100 cfu/mL. TVC of <0.1 and <100 cfu/mL were achieved in 71.5 and 99.0% of the facilities that responded, respectively (Table 17).

Three thousand eight hundred forty of the facilities (89.2%) responded to the question about the culturing media for TVC. In the JSDT standard, Reasoner’s No. 2 agar (R2A) and tryptone glucose extract agar (TGEA) are recommended for TVC in dialysis fluid. The survey results showed that either of these media was used by 86.2% of the facilities that responded.

Three thousand nine hundred fifty of the facilities (91.8%) responded to the question about the sampling volume for TVC. As previously addressed, the JSDT standard recommended that UPD should be indicated for all types of extracorporeal dialysis treatments [7]. The requirement of TVC for UPD is <0.1 cfu/mL so it needs equal or greater than 10 mL of sampling volume of dialysis fluid. At least 10 mL of sampling was performed in 77.1% of the facilities that responded (Table 18). As previously addressed, UPD should satisfy both an endotoxin <0.001 EU/mL and TVC of <0.1 cfu/mL. However, the percentage of the facilities that satisfied TVC of <0.1 cfu/mL (71.5%) was approximately 6% lower than that of the facilities that satisfied the endotoxin <0.001 EU/mL (77.6%), indicating the need for the improvement of dialysis fluid quality control.
Table 18

Facility distribution on microbial measurement by cultivating medium and sampling volume

Sampling volume

Nutrient agar

R2A

TGEA

Blood agar

TSA

Others

Subtotal

Unspecified

No information available

Total

<1

54

161

45

3

3

12

278

22

 

300

(%)

(19.4)

(57.9)

(16.2)

(1.1)

(1.1)

(4.3)

(100.0)

   

1, < 10

90

404

44

6

5

14

563

42

 

605

(%)

(16.0)

(71.8)

(7.8)

(1.1)

(0.9)

(2.5)

(100.0)

   

10, <50

62

645

352

4

13

74

1150

25

 

1175

(%)

(5.4)

(56.1)

(30.6)

(0.3)

(1.1)

(6.4)

(100.0)

   

50, < 100

45

642

571

1

13

85

1357

17

1

1375

(%)

(3.3)

(47.3)

(42.1)

(0.1)

(1.0)

(6.3)

(100.0)

   

100, <500

19

263

146

 

2

17

447

13

 

460

(%)

(4.3)

(58.8)

(32.7)

 

(0.4)

(3.8)

(100.0)

   

500, < 1000

2

10

4

1

  

17

1

 

18

(%)

(11.8)

(58.8)

(23.5)

(5.9)

  

(100.0)

   

1000, <10,000

 

8

5

  

1

14

1

 

15

(%)

 

(57.1)

(35.7)

  

(7.1)

(100.0)

   

10,000

 

1

1

   

2

  

2

(%)

 

(50.0)

(50.0)

   

(100.0)

   

Subtotal

272

2134

1168

15

36

203

3828

121

1

3950

(%)

(7.1)

(55.7)

(30.5)

(0.4)

(0.9)

(5.3)

(100.0)

   

Unspecified

3

8

1

   

12

232

 

244

(%)

(25.0)

(66.7)

(8.3)

   

(100.0)

   

No information available

        

110

110

(%)

          

Total

275

2142

1169

15

36

203

3840

353

110

4304

(%)

(7.2)

(55.8)

(30.4)

(0.4)

(0.9)

(5.3)

(100.0)

   

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

R2A Reasoner’s No. 2 agar, TGEA Tryptone glucose extract agar, TSA Trypticase soy agar

Installation of endotoxin retentive filters

Four thousand two hundred ninety-five (99.8%) responded to questions regarding the installation of endotoxin retentive filters (ETRFs). Among these 4295 facilities, 96.3% had at least one bedside console equipped with an ETRF (Table 19). The 4304 facilities that responded to the questions about the installation of ETRFs had a total of 131,555 bedside consoles, 88.6% of which were equipped with an ETRF. The percentage of bedside consoles equipped with an ETRF increased by 2.6% from the previous year (86.0%) (Table 20) [2].
Table 19

Facility counts by ETRF installation

 

With ETRF

Without ETRF

Subtotal

No information available

Total

Number of facilities

4136

159

4295

9

4304

(%)

(96.3)

(3.7)

(100.0)

  

Values in parentheses under each figure represent the percentage relative to the subtotal in the row

Table 20

Bedside console counts by ETRF installation

Numbers of bedside consoles

Facility status of ETRF installation

Subtotal

No information available

Total

More than one bedside console with ETRF in the facility

No bedside consoles with ETRF in the facility

Number of bedside consoles with ETRF

116,527

0

116,527

0

116,527

(%)

(100.0)

(0.0)

(100.0)

  

Number of bedside consoles without ETRF

11,657

3178

14,835

193

15,028

(%)

(78.6)

(21.4)

(100.0)

  

Total

128,184

3178

131,362

193

131,555

(%)

(97.6)

(2.4)

(100.0)

  

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

ETRF endotoxin retentive filter

Theoretically, UPD can be achieved by using an ETRF based on its retentive performance. If facilities cannot achieve UPD even with ETRF, these facilities may have some problems in preventing the contaminations, such as a high contamination level of raw water, a high level of secondary contamination, contamination of ETRF itself, or contamination during sampling. These facilities need to optimize their maneuver of the disinfection of the entire system. The percentages of facilities that did not achieve the required endotoxin of <0.001 EU/mL and TVC of <0.1 cfu/mL with ETRFs were 20.1 and 25.9%, respectively (Tables 21 and 22). Standard dialysis fluid should have an endotoxin of <0.050 EU/mL and TVC of <100 cfu/mL. Among the facilities that had bedside consoles equipped with an ETRF, 3.3% did not achieve the required endotoxin and 0.8% did not achieve the required TVC. In contrast, 66.7 and 58.5% of the facilities without ETRFs satisfied the endotoxin and TVC of UPD, respectively. These results suggest that the technologies for purifying dialysis fluid have advanced to ensure the purification in the entire dialysate supply system. However, the data also suggested that dialysis fluid was contaminated by mal-handlings of an ETRF in some cases.
Table 21

Facility distribution on endotoxin measurement by endotoxin concentration and ETRF installation on sampling

With or without ETRF when the dialysate was sampled

<0.001

0.001, <0.01

0.01, <0.05

0.05, <0.1

0.1, < 0.25

0.25, <0.5

0.5

Subtotal

Unspecified

No information available

Total

Without ETRF

412

120

51

10

15

5

5

618

72

21

711

(%)

(13.1)

(22.2)

(24.8)

(16.4)

(31.9)

(27.8)

(23.8)

(15.3)

(62.6)

(100.0)

(17.0)

With ETRF

2742

421

155

51

32

13

16

3430

43

 

3473

(%)

(86.9)

(77.8)

(75.2)

(83.6)

(68.1)

(72.2)

(76.2)

(84.7)

(37.4)

 

(83.0)

Subtotal

3154

541

206

61

47

18

21

4048

115

21

4184

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Unspecified

13

7

5

2

1

2

1

31

49

4

84

(%)

           

No information available

         

36

36

(%)

           

Total

3167

548

211

63

48

20

22

4079

164

61

4304

(%)

           

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

ETRF endotoxin retentive filter

Table 22

Facility distribution on microbial measurement by TVC and ETRF installation on sampling

With or without ETRF when the dialysate was sampled

<0.1

0.1~

1~

10~

100〜

Subtotal

Unspecified

No information available

Total

Without ETRF

339

108

73

45

14

579

100

32

711

(%)

(12.1)

(19.8)

(20.2)

(29.6)

(35.0)

(14.8)

(46.1)

(47.1)

(17.0)

With ETRF

2461

437

289

107

26

3320

117

36

3473

(%)

(87.9)

(80.2)

(79.8)

(70.4)

(65.0)

(85.2)

(53.9)

(52.9)

(83.0)

Subtotal

2800

545

362

152

40

3899

217

68

4184

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Unspecified

11

6

10

4

 

31

47

6

84

(%)

         

No information available

       

36

36

(%)

         

Total

2811

551

372

156

40

3930

264

110

4304

(%)

         

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

ETRF endotoxin retentive filter, TVC total viable microbial count

Endotoxin concentration and TVC in dialysis fluid

According to the JSDT standard for on the microbiological quality of dialysis fluid, UPD is recommended for all dialysis methods [7]. UPD is defined as an endotoxin of <0.001 EU/mL (lower than the detection limit) and TVC of <0.1 cfu/mL [7]. Among the 4304 facilities that had at least one bedside console, 3919 (91.1%) responded to each question of endotoxin and TVC in dialysis fluid, among which, 2602 satisfied the above standards for UPD. They accounted for 66.4% of the facilities that responded to the questions and 60.5% of all the facilities, which were higher than those in the previous year, 60.8 and 54.9%, respectively (Table 23).
Table 23

Facility distribution by endotoxin concentration and TVC

Bacterial counts in dialysate (cfu/mL)

<0.001

0.001, <0.01

0.01, <0.05

0.05, <0.1

0.1, <0.25

0.25, <0.5

0.5

Subtotal

Unspecified

No information available

Total

<0.1

2602

153

29

9

7

3

3

2806

5

 

2811

(%)

(92.7)

(5.5)

(1.0)

(0.3)

(0.2)

(0.1)

(0.1)

(100.0)

   

0.1~

291

186

43

16

5

2

4

547

4

 

551

(%)

(53.2)

(34.0)

(7.9)

(2.9)

(0.9)

(0.4)

(0.7)

(100.0)

   

1~

137

125

67

11

21

5

4

370

2

 

372

(%)

(37.0)

(33.8)

(18.1)

(3.0)

(5.7)

(1.4)

(1.1)

(100.0)

   

10~

40

45

35

17

7

6

6

156

  

156

(%)

(25.6)

(28.8)

(22.4)

(10.9)

(4.5)

(3.8)

(3.8)

(100.0)

   

100〜

12

6

9

4

3

3

3

40

  

40

(%)

(30.0)

(15.0)

(22.5)

(10.0)

(7.5)

(7.5)

(7.5)

(100.0)

   

Subtotal

3082

515

183

57

43

19

20

3919

11

 

3930

(%)

(78.6)

(13.1)

(4.7)

(1.5)

(1.1)

(0.5)

(0.5)

(100.0)

   

Unspecified

61

23

16

5

4

1

1

111

151

2

264

(%)

(55.0)

(20.7)

(14.4)

(4.5)

(3.6)

(0.9)

(0.9)

(100.0)

   

No information available

24

10

12

1

1

 

1

49

2

59

110

(%)

(49.0)

(20.4)

(24.5)

(2.0)

(2.0)

 

(2.0)

(100.0)

   

Total

3167

548

211

63

48

20

22

4079

164

61

4304

(%)

(77.6)

(13.4)

(5.2)

(1.5)

(1.2)

(0.5)

(0.5)

(100.0)

   

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

TVC total viable microbial count

Changes in status of quality control of dialysis fluid

In the early 2000s, microbial contamination of dialysis fluid was considered an important factor affecting the quality of dialysis treatment. Moreover, a concern on the high possibility of bacterial contaminations in centralized dialysis fluid delivery system (CDDS) widely used in Japan was raised by overseas researchers. In response to this, the survey of the endotoxin level and TVC in dialysis fluid was started in 2006. The results have been referenced in revising the JSDT standard and the targets of endotoxin and TVC were changed in 2008, 2010, and 2012 [79]. Such a large-scale survey on dialysis fluid quality has been carried out and used for the revision of the standard only in Japan. With the above historical background, how the status of bacteriological contamination of dialysis fluid changed between 2006 and 2014 is reviewed below [2, 6, 1015].

The percentage of facilities that measured endotoxin in dialysis fluid at least once a month was 36.0% in 2009, increased to 70.6% in 2010 because of the revision of the medical reimbursement, and continued to gradually increase to 78.7% in 2014 (Table 24). The measured endotoxin in dialysis fluid decreased yearly; 77.6% of the facilities achieved the required endotoxin of UPD (<0.001 EU/mL), and 96.2% of the facilities achieved the required endotoxin concentration of standard dialysis fluid (<0.050 EU/mL) (Table 25). In the 2008 survey, the endotoxin unit was changed from EU/L to EU/mL in accordance with the international standards. Because many errors resulting from the misunderstanding of the unit were found in the responses, the endotoxin concentration in dialysis fluid in the 2008 was excluded.
Table 24

Annual changes in frequency of endotoxin measurement

Frequency of measurement (per month)

2006

2007

2008

2009

2010

2011

2012

2013

2014

1

953

1153

1253

1373

2810

2914

3141

3238

3329

(%)

(27.3)

(31.5)

(33.1)

(36.0)

(70.6)

(71.9)

(76.3)

(77.7)

(78.7)

<1

2535

2511

2531

2436

1170

1137

977

929

900

(%)

(72.7)

(68.5)

(66.9)

(64.0)

(29.4)

(28.1)

(23.7)

(22.3)

(21.3)

Subtotal

3488

3664

3784

3809

3980

4051

4118

4167

4229

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Unspecified

185

209

244

193

92

99

77

65

69

No information available

312

179

53

48

52

27

8

3

6

Total

3985

4052

4081

4050

4124

4177

4203

4235

4304

Values in parentheses under each figure represent the percentage relative to the total in each column

Table 25

Annual change in endotoxin concentration in dialysis fluid

 

2006

2007

2008

2009

2010

2011

2012

2013

2014

<0.001

817

1688

1865

2343

2549

2787

2963

3167

(%)

(29.8)

(53.0)

(56.1)

(62.1)

(66.0)

(70.7)

(73.9)

(77.6)

0.001, <0.05

1627

1295

933

1115

1042

938

849

759

(%)

(59.2)

(40.6)

(28.1)

(29.6)

(27.0)

(23.8)

(21.2)

(18.6)

0.05

302

203

527

314

271

216

195

153

(%)

(11.0)

(6.4)

(15.8)

(8.3)

(7.0)

(5.5)

(4.9)

(3.8)

Subtotal

2746

3186

3325

3772

3862

3941

4007

4079

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Unspecified

215

253

105

112

197

148

164

No information available

1239

651

472

247

203

65

80

61

Total

3985

4052

4050

4124

4177

4203

4235

4304

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

In the 2008 survey, the measurement unit for the endotoxin level in the dialysate was changed from EU/L to EU/mL. The values in 2008 are considered to include many errors and are not shown here

The target of TVC in dialysis fluid was not included in the JSDT guidelines on dialysate quality control standards in 2005 [16]. Owing to the revision of the standard in 2008, it was recommended to measure TVC at least once a month similarly as well as endotoxin level [7]. In 2007 or previously, only 10–19% of the facilities measured TVC at least once a month. In 2010, however, the percentage of such facilities rapidly increased to 67.8% because of the revision of the medical reimbursement in that year and it gradually increased to 74.8% in 2014 (Table 26). The percentage of facilities that satisfied TVC for UPD (<0.1 cfu/mL) gradually increased to 71.5% in 2014. The percentage of facilities that satisfied standard dialysis fluid (<100 cfu/mL) was 99.0% (Table 27).
Table 26

Annual changes in frequency of TVC measurement

Frequency of measurement (per month)

2006

2007

2008

2009

2010

2011

2012

2013

2014

1

371

580

751

934

2649

2794

3018

3091

3148

(%)

(11.5)

(16.9)

(20.8)

(25.8)

(67.8)

(70.0)

(73.7)

(74.7)

74.8%

<1

2857

2861

2856

2693

1260

1196

1077

1046

1059

(%)

(88.5)

(83.1)

(79.2)

(74.2)

(32.2)

(30.0)

(26.3)

(25.3)

(25.2)

Subtotal

3228

3441

3607

3627

3909

3990

4095

4137

4207

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Unspecified

386

412

418

367

158

159

100

94

90

No information available

371

199

56

56

57

28

8

4

7

Total

3985

4052

4081

4050

4124

4177

4203

4235

4304

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

TVC total viable microbial count

Table 27

Annual changes in TVC in dialysis fluid

TVC (cfu/mL)

2006

2007

2008

2009

2010

2011

2012

2013

2014

<0.1

508

750

915

1123

1819

2017

2397

2570

2811

(%)

(48.4)

(47.9)

(50.7)

(54.5)

(53.1)

(56.4)

(63.8)

(67.1)

(71.5)

0.1, <100

509

775

847

901

1542

1498

1305

1214

1079

(%)

(48.5)

(49.5)

(46.9)

(43.7)

(45.0)

(41.9)

(34.7)

(31.7)

(27.5)

100

32

40

43

38

62

62

55

46

40

(%)

(3.1)

(2.6)

(2.4)

(1.8)

(1.8)

(1.7)

(1.5)

(1.2)

(1.0)

Subtotal

1049

1565

1805

2062

3423

3577

3757

3830

3930

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Unspecified

2036

552

575

494

216

227

320

273

264

No information available

900

1935

1701

1494

485

373

126

132

110

Total

3985

4052

4081

4050

4124

4177

4203

4235

4304

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

TVC total viable microbial count

Chapter 3: Current status of hemodiafiltration

Basal characteristics of HDF patients

Since the revision of the medical reimbursement for HDF made in April 2012 [9], the number of patients treated by online HDF have been rapidly increasing. The HDF patient count was 14,069 in 2012 and increased by 2.5-fold up to 36,090 in 2014 (Table 28) [2, 6, 1315] whereas, the count of the patients on offline HDF decreased from 7157 in 2012 to 6315 in 2014. The percentage of patients on HDF of all dialysis patients has increased from 7.5% in 2012 to 14.5% in 2014.
Table 28

Annual patient count by in-center extracorporeal dialysis modality

Dialysis method

2009

2010

2011

2012

2013

2014

Facility HD

253,807

262,973

270,072

268,275

264,211

255,641

HDF

On-line HDF

6852

4829

4890

14,069

23,536

36,090

(%)

(40.7)

(32.5)

(34.6)

(64.8)

(75.0)

(83.4)

Off-line HDF

9299

9421

8573

7157

7149

6315

(%)

(55.2)

(63.4)

(60.7)

(32.9)

(22.8)

(14.6)

Push/Pull HDF

237

159

145

109

263

537

(%)

(1.4)

(1.1)

(1.0)

(0.5)

(0.8)

(1.2)

AFBF

465

458

507

390

423

341

(%)

(2.8)

(3.1)

(3.6)

(1.8)

(1.3)

(0.8)

HDF subtotal

16,853

14,867

14,115

21,725

31,371

43,283

 

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

HD + HDF total

270,660

277,840

284,187

290,000

295,582

298,924

Values in parentheses under each figure represent the percentage relative to the HDF subtotal in each column

HD hemodialysis, HDF hemodiafiltration

The HDF patients’ distributions by age and gender were summarized (Table 29). For both males and females, the number of patients on HDF in the age group of 65–70 years was the largest, showing no significant difference in the age distribution by gender.
Table 29

Patient distribution on all types of HDF by gender and age

Age

Male

Female

Subtotal

No information available

Total

<5

2

 

2

 

2

(%)

(0.0)

 

(0.0)

 

(0.0)

5~9

     

(%)

     

10~14

     

(%)

     

15~19

7

5

12

 

12

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

20~24

24

12

36

 

36

(%)

(0.1)

(0.1)

(0.1)

 

(0.1)

25~29

87

37

124

 

124

(%)

(0.3)

(0.2)

(0.3)

 

(0.3)

30~34

199

96

295

 

295

(%)

(0.7)

(0.6)

(0.7)

 

(0.7)

35~39

514

212

726

 

726

(%)

(1.9)

(1.3)

(1.7)

 

(1.7)

40~44

1155

491

1646

 

1646

(%)

(4.2)

(3.1)

(3.8)

 

(3.8)

45~49

1671

781

2452

 

2452

(%)

(6.1)

(4.9)

(5.7)

 

(5.7)

50~54

2142

1016

3158

 

3158

(%)

(7.8)

(6.4)

(7.3)

 

(7.3)

55~59

2837

1452

4289

 

4289

(%)

(10.4)

(9.1)

(9.9)

 

(9.9)

60~64

4064

2369

6433

 

6433

(%)

(14.9)

(14.8)

(14.9)

 

(14.9)

65~69

4802

2863

7665

 

7665

(%)

(17.6)

(17.9)

(17.7)

 

(17.7)

70~74

4010

2467

6477

 

6477

(%)

(14.7)

(15.5)

(15.0)

 

(15.0)

75~79

2927

1903

4830

 

4830

(%)

(10.7)

(11.9)

(11.2)

 

(11.2)

80~84

1903

1352

3255

 

3255

(%)

(7.0)

(8.5)

(7.5)

 

(7.5)

85~89

781

706

1487

 

1487

(%)

(2.9)

(4.4)

(3.4)

 

(3.4)

90~94

171

180

351

 

351

(%)

(0.6)

(1.1)

(0.8)

 

(0.8)

95

17

25

42

 

42

(%)

(0.1)

(0.2)

(0.1)

 

(0.1)

Subtotal

27,313

15,967

43,280

 

43,280

(%)

(100.0)

(100.0)

(100.0)

 

(100.0)

Unknown

3

 

3

 

3

No information available

     

Total

27,316

15,967

43,283

 

43,283

Mean age

64.32

66.30

65.05

 

65.05

S.D.

12.40

12.27

12.39

 

12.39

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

HDF hemodiafiltration

The primary diseases of the HDF patients were compared with in-center HD patients (Table 30). The prevalence of diabetes was lower in HDF patients than in in-center HD patients. Chronic glomerulonephritis was the most common in the HDF patients (37.7%), followed by diabetes (33.0%). This finding may be attributable to the fact that many of the HDF patients have a longer dialysis vintage than the in-center HD patients.
Table 30

Patient distribution by in-center HD/HDF and primary disease

Primary disease

In-cnter HD

(%)

HDF

(%)

Chronic glomerular nephritis

76,117

(29.8)

16,311

(37.7)

Chronic pyelonephritis

2456

(1.0)

462

(1.1)

RPGN

2106

(0.8)

304

(0.7)

PIH

1156

(0.5)

378

(0.9)

Unclassified nephritis

1058

(0.4)

207

(0.5)

PKD

9081

(3.6)

1593

(3.7)

Nephrosclerosis

24,036

(9.4)

3132

(7.2)

Hypertensive emergencies

2110

(0.8)

346

(0.8)

Diabetes

100,830

(39.4)

14,284

(33.0)

Lupus

1757

(0.7)

394

(0.9)

Amyloidosis

376

(0.1)

64

(0.1)

Gout

907

(0.4)

163

(0.4)

Inborn errors of metabolism

201

(0.1)

50

(0.1)

Tuberculosis

175

(0.1)

24

(0.1)

Urolithiasis

488

(0.2)

72

(0.2)

Neoplasm of kidney and urinary tract

771

(0.3)

100

(0.2)

Urinary tract obstructive

616

(0.2)

80

(0.2)

Myeloma

245

(0.1)

23

(0.1)

Hypoplastic kidney

455

(0.2)

111

(0.3)

Undetermined

22,799

(8.9)

3763

(8.7)

Rejected kidney

1613

(0.6)

450

(1.0)

Others

6288

(2.5)

972

(2.2)

Subtotal

255,641

(100.0)

43,283

(100.0)

No information available

    

Total

255,641

 

43,283

 

Values in parentheses on the right side of each figure represent the percentage relative to the subtotal in each column

HD hemodialysis, HDF hemodiafiltration, RPGN Rapidly progressive glomerulonephritis, PIH Pregnancy-induced hypertension, PKD polycystic kidney disease

The dialysis vintages of HDF patients were evaluated by gender (Table 31) and were compared among various extracorporeal dialysis modalities (Table 32). For dialysis vintages of <20 years, the percentage of male patients was higher than that of female patients. For dialysis vintages of ≥20 years, the ratio of males to females was nearly 1:1. Even among the patients with dialysis vintages of <2 years, 7.5% underwent online HDF. The percentage of patients on online HDF increased with increasing dialysis vintage. This suggests that at the time immediately after the start of dialysis, online HDF might be selected for the prevention of dialysis-related complications in the future.
Table 31

Patient distribution on all types of HDF by gender and dialysis vintage

Gender

0~1

2~4

5~9

10~14

15~19

20~24

25~29

30~34

35~39

40~

Subtotal

Unknown

No information available

Total

Mean

S.D.

Male

3795

6465

7093

4101

2442

1489

926

593

338

63

27,305

11

0

27,316

9.15

8.41

(%)

(68.7)

(69.0)

(65.2)

(61.3)

(57.9)

(52.7)

(51.5)

(49.7)

(53.8)

(46.3)

(63.1)

     

Female

1731

2910

3784

2592

1776

1338

871

601

290

73

15,966

1

0

15,967

11.36

9.43

(%)

(31.3)

(31.0)

(34.8)

(38.7)

(42.1)

(47.3)

(48.5)

(50.3)

(46.2)

(53.7)

(36.9)

     

Subtotal

5526

9375

10,877

6693

4218

2827

1797

1194

628

136

43,271

12

0

43,283

9.97

8.86

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

     

No information available

0

0

0

0

0

0

0

0

0

0

0

0

0

0

  

Total

5526

9375

10,877

6693

4218

2827

1797

1194

628

136

43,271

12

 

43,283

9.97

8.86

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

HDF hemodiafiltration

Table 32

Patient distribution on in-center extracorporal dialysis by modality and dialysis vintage

Dialysis modality

0~1

2~4

5~9

10~14

15~19

20~24

25~29

30~34

35~39

40~

Subtotal

Unknown

No information available

Total

Mean

S.D.

In-center HD

58,953

65,244

65,126

32,837

16,641

8638

4382

2374

1132

245

255,572

69

 

255,641

6.85

7.01

(%)

(91.4)

(87.4)

(85.7)

(83.1)

(79.8)

(75.3)

(70.9)

(66.5)

(64.3)

(64.3)

(85.5)

(85.2)

 

(85.5)

  

Off-line HDF

561

1022

1473

1050

719

538

426

314

169

40

6312

3

 

6315

12.54

9.97

(%)

(0.9)

(1.4)

(1.9)

(2.7)

(3.4)

(4.7)

(6.9)

(8.8)

(9.6)

(10.5)

(2.1)

(3.7)

 

(2.1)

  

On-line HDF

4836

8177

9144

5508

3429

2242

1340

864

448

93

36,081

9

 

36,090

9.54

8.59

(%)

(7.5)

(11.0)

(12.0)

(13.9)

(16.4)

(19.6)

(21.7)

(24.2)

(25.5)

(24.4)

(12.1)

(11.1)

 

(12.1)

  

Push/Pull HDF

97

115

162

77

37

25

17

6

1

 

537

  

537

7.95

7.24

(%)

(0.2)

(0.2)

(0.2)

(0.2)

(0.2)

(0.2)

(0.3)

(0.2)

(0.1)

 

(0.2)

  

(0.2)

  

AFBF

32

61

98

58

33

22

14

10

10

3

341

  

341

11.07

9.41

(%)

(0.0)

(0.1)

(0.1)

(0.1)

(0.2)

(0.2)

(0.2)

(0.3)

(0.6)

(0.8)

(0.1)

  

(0.1)

  

Total

64,479

74,619

76,003

39,530

20,859

11,465

6179

3568

1760

381

298,843

81

 

298,924

7.29

7.49

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

 

(100.0)

  

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

HDF hemodiafiltration, AFBF acetate free biofiltration

Dilution mode and substitution volume

The majority of the patients on online HDF (91.8%) was treated by predilution, whereas that of offline HDF (86.8%) was performed in postdilution (Table 33). The mean substitution volume was compared between the patients on online and offline HDF by dilution mode (Table 34). In online HDF, the mean volumes were 39.6 and 10.6 L for predilution and postdilution, respectively. In offline HDF, the mean volumes were 10.2 and 8.0 L for predilution and postdilution, respectively.
Table 33

Patient distribution by dilution mode and HDF modality

 

Predilution

Postdilution

Predilution and postdilution

Other dilution mode

Subtotal

Unspecified

No information available

Total

On-line HDF

29,881

1342

0

1317

32,540

1

3549

36,090

(%)

(91.8)

(4.1)

(0.0)

(4.0)

(100.0)

   

Off-line HDF

638

4275

5

5

4923

 

1392

6315

(%)

(13.0)

(86.8)

(0.1)

(0.1)

(100.0)

   

Push/Pull HDF

8

88

0

266

362

 

175

537

(%)

(2.2)

(24.3)

(0.0)

(73.5)

(100.0)

   

AFBF

2

154

 

1

157

 

184

341

(%)

(1.3)

(98.1)

(0.0)

(0.6)

(100.0)

   

Total

30,529

5859

5

1589

37,982

1

5300

43,283

(%)

(80.4)

(15.4)

(0.0)

(4.2)

(100.0)

   

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

HDF hemodiafiltration, AFBF acetate free biofiltration

Table 34

Mean substitution volume by dilution mode and online/offline

  

Predillution

Postdilution

Predilution and postdilution

Other dilution mode

Subtotal

Unspecified

No information available

Total

On-line HDF

Number of patients

29,881

1342

0

1317

32,540

1

3549

36,090

Mean volumes of substitution fluid per session (L)

39.6

10.6

 

1.5

37.4

  

37.4

S.D.

15.8

5.0

 

1.2

17.4

  

17.4

Off-line HDF

Number of patients

638

4275

5

5

4923

0

1392

6315

Mean volumes of substitution fluid per session (L)

10.2

8.0

9.0

1.3

8.3

  

8.3

S.D.

6.6

2.3

1.4

0.5

3.3

  

3.3

HDF hemodiafiltration

Changes in the substitution volume per session of online HDF between 2012 and 2014 are shown for the predilution (Table 35) and postdilution (Table 36) [2, 15]. For the predilution, the numbers of patients in all groups stratified by the volume of substitution fluid increased. However, the mean substitution volume in the entire online HDF patients remained almost unchanged at approximately 40 L in 2012–2014. The group of patients with 40–50 L of substitution volume was the largest in each year, and the percentage of this group increased over time. For the postdilution, the numbers of patients in the stratified groups with ≥10 L of substitution fluid tended to increase. In particular, the number of patients in the group with ≥20 L of substitution greatly increased over time, although the absolute number was still small. This finding indicates that an increasing number of patients has undergone postdilution online HDF using a large volume of substitution fluid, which is mainly performed in Europe.
Table 35

Annual changes in substitution volume of predilution online HDF

Year

1~

10~

20~

30~

40~

50~

60~

70~

80~

Subtotal

Unknown

Total

Mean

S.D.

2012

415

711

1829

2320

3373

913

1102

345

145

11,153

122

11,275

39.1

16.7

(%)

(3.7)

(6.4)

(16.4)

(20.8)

(30.2)

(8.2)

(9.9)

(3.1)

(1.3)

(100.0)

    

2013

464

936

2728

3730

6791

1558

2009

445

316

18,977

267

19,244

40.6

15.8

(%)

(2.4)

(4.9)

(14.4)

(19.7)

(35.8)

(8.2)

(10.6)

(2.3)

(1.7)

(100.0)

    

2014

1030

1347

4583

5399

10,512

2138

2693

563

450

28,715

1166

29,881

39.6

15.8

(%)

(3.6)

(4.7)

(16.0)

(18.8)

(36.6)

(7.4)

(9.4)

(2.0)

(1.6)

(100.0)

    

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

HDF hemodiafiltration

Table 36

Annual changes in substitution volume of postdilution online HDF

Year

1~

5~

10~

15~

20~

Subtotal

Unknown

Total

Mean

S.D.

2012

31

289

460

113

24

917

36

953

10.6

3.9

(%)

(3.4)

(31.5)

(50.2)

(12.3)

(2.6)

(100.0)

    

2013

172

536

474

104

35

1321

118

1439

9.2

4.5

(%)

(13.0)

(40.6)

(35.9)

(7.9)

(2.6)

(100.0)

    

2014

89

482

501

104

137

1313

29

1342

10.6

5.0

(%)

(6.8)

(36.7)

(38.2)

(7.9)

(10.4)

(100.0)

    

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

HDF hemodiafiltration

The changes in the substitution volume per session of offline HDF between 2012 and 2014 are shown for the predilution (Table 37) and the postdilution (Table 38) [2, 15]. The number of patients on predilution offline HDF was small but slightly increased, and the substitution volume among them also tended to increase. In contrast, in 2014, the number of patients on postdilution offline HDF decreased by approximately 1000 from the previous year. However, the percentages of patients with different volumes of substitution fluid have hardly changed in the 3 years and the mean volume of substitution fluid remained at approximately 8 L.
Table 37

Annual changes in substitution volume of predilution offline HDF

Year

1~

5~

10~

15~

20~

Subtotal

Unknown

Total

Mean

S.D.

2012

20

200

207

7

22

456

29

485

9.2

3.8

(%)

(4.4)

(43.9)

(45.4)

(1.5)

(4.8)

(100.0)

    

2013

40

252

227

5

36

560

20

580

9.4

4.7

(%)

(7.1)

(45.0)

(40.5)

(0.9)

(6.4)

(100.0)

    

2014

89

222

209

15

83

618

20

638

10.2

6.6

(%)

(14.4)

(35.9)

(33.8)

(2.4)

(13.4)

(100.0)

    

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

HDF hemodiafiltration

Table 38

Annual changes in substitution volume of postdilution offline HDF

Year

1~

5~

10~

15~

20~

Subtotal

Unknown

Total

Mean

S.D.

2012

492

2845

1620

16

5

4978

71

5049

7.8

2.3

(%)

(9.9)

(31.5)

(50.2)

(12.3)

(2.6)

(100.0)

    

2013

508

2775

1722

16

13

5034

180

5214

7.9

2.4

(%)

(10.1)

(55.1)

(34.2)

(0.3)

(0.3)

(100.0)

    

2014

338

2235

1492

11

7

4083

192

4275

8.0

2.3

(%)

(8.3)

(54.7)

(36.5)

(0.3)

(0.2)

(100.0)

    

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

HDF hemodiafiltration

The dialysis prescription is usually affected by the patient’s body size. The substitution volumes for HDF therapy were evaluated by body weight according to the dilution mode and gender. In the male patients on predilution HDF with body weight <50 kg, the percentages of the substitution volume as 20–40 and 40–80 L were similar. In case of body weight ≥50 kg, the percentage of those using 40–80 L of substitution fluid increased and exceeded 60% in the group of male patients who weighed ≥60 kg (Table 39). In the female patients on predilution HDF with body weight <40 kg, the percentage of 20–40 L of substitution fluid was almost the same as that of patients using 40–80 L. In case of body weight ≥50 kg, the percentage of 20–40 L of substitution fluid was almost the same as 40–80 L. The titration of substitution volume according to body weight was observed only in males but not in females (Table 40). In the postdilution mode, the male patients with body weight <50 kg were mostly treated with 5–10 L of substitution volume. In the male patients with body weight 60–70 kg, the patients treated with 10–20 L of substitution fluid was similar to that of 5–10 L. In the patients with body weight ≥70 kg, the percentage of patients using 10–20 L of substitution fluid was the highest (Table 41). In the female patients, the percentage of patients using 5–10 L of substitution fluid was greater than 50% in all weight groups (Table 42).
Table 39

Male patient distribution on predilution HDF by postdialysis body weight and substitution volume

Substitution volume (L/session)

Postdialysis body weight (kg)

Total

<40

40~50

50~60

60~70

70~80

80~

<5

6

67

110

87

33

9

312

(%)

(3.0)

(2.7)

(1.7)

(1.6)

(1.4)

(0.7)

(1.7)

5~

11

88

165

108

53

15

440

(%)

(5.5)

(3.5)

(2.6)

(2.0)

(2.3)

(1.1)

(2.4)

10~

22

179

335

228

91

47

902

(%)

(11.1)

(7.1)

(5.2)

(4.3)

(3.9)

(3.4)

(5.0)

20~

80

1022

2183

1588

610

343

5826

(%)

(40.2)

(40.6)

(34.1)

(30.1)

(26.2)

(24.8)

(32.2)

40~

76

1128

3511

3187

1494

927

10,323

(%)

(38.2)

(44.9)

(54.8)

(60.3)

(64.2)

(67.0)

(57.0)

80~

4

31

99

86

45

43

308

(%)

(2.0)

(1.2)

(1.5)

(1.6)

(1.9)

(3.1)

(1.7)

Total

199

2515

6403

5284

2326

1384

18,111

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

HDF hemodiafiltration

Table 40

Female patient distribution on predilution HDF by postdialysis body weight and substitution volume

Substitution volume (L/session)

Postdialysis body weight (kg)

Total

<40

40~50

50~60

60~70

70~80

80~

<5

48

79

43

17

3

0

190

(%)

(3.0)

(1.8)

(1.6)

(1.8)

(1.1)

(0.0)

(1.9)

5~

81

163

78

33

6

3

364

(%)

(5.1)

(3.6)

(2.9)

(3.6)

(2.1)

(2.2)

(3.6)

10~

136

302

131

42

9

4

624

(%)

(8.5)

(6.7)

(4.9)

(4.5)

(3.2)

(2.9)

(6.2)

20~

672

1664

890

297

106

44

3673

(%)

(42.2)

(36.9)

(33.4)

(32.0)

(37.5)

(31.9)

(36.3)

40~

641

2247

1487

520

157

80

5132

(%)

(40.2)

(49.9)

(55.8)

(56.0)

(55.5)

(58.0)

(50.7)

80~

15

49

38

19

2

7

130

(%)

(0.9)

(1.1)

(1.4)

(2.0)

(0.7)

(5.1)

(1.3)

Total

1593

4504

2667

928

283

138

10,113

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

HDF hemodiafiltration

Table 41

Male patient distribution on postdilution HDF by postdialysis body weight and substitution volume

Substitution fluid volume (L/session)

Postdialysis body weight (kg)

Total

<40

40~50

50~60

60~70

70~80

80~

<5

4

39

78

38

21

10

190

(%)

(10.0)

(7.6)

(6.7)

(4.5)

(6.3)

(4.6)

(6.1)

5~

23

276

575

395

138

76

1483

(%)

(57.5)

(53.9)

(49.6)

(46.7)

(41.3)

(35.0)

(47.7)

10~

11

186

478

380

158

118

1331

(%)

(27.5)

(36.3)

(41.2)

(45.0)

(47.3)

(54.4)

(42.8)

20~

2

11

29

32

17

13

104

(%)

(5.0)

(2.1)

(2.5)

(3.8)

(5.1)

(6.0)

(3.3)

40~

0

0

0

0

0

0

0

(%)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

80~

0

0

0

0

0

0

0

(%)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

Total

40

512

1160

845

334

217

3108

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

HDF hemodiafiltration

Table 42

Female patient distribution on postdilution HDF by postdialysis body weight and substitution volume

Substitution fluid volume (liter per session)

Postdialysis body weight (kg)

Total

<40

40~50

50~60

60~70

70~80

80~

<5

60

88

51

9

5

0

213

(%)

(13.9)

(9.5)

(10.1)

(6.0)

(12.2)

(0.0)

(10.2)

5~

255

490

259

83

24

10

1121

(%)

(58.9)

(52.6)

(51.3)

(55.3)

(58.5)

(50.0)

(53.9)

10~

113

336

189

53

11

8

710

(%)

(26.1)

(36.1)

(37.4)

(35.3)

(26.8)

(40.0)

(34.1)

20~

5

17

6

5

1

2

36

(%)

(1.2)

(1.8)

(1.2)

(3.3)

(2.4)

(10.0)

(1.7)

40~

0

0

0

0

0

0

0

(%)

       

80~

0

0

0

0

0

0

0

(%)

       

Total

433

931

505

150

41

20

2080

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

Values in parentheses under each figure represent the percentage relative to the subtotal in each column

HDF hemodiafiltration

Blood flow rate and dialysis time

The distributions of blood flow rate in each HDF modality were summarized in Table 43. At least half of the online HDF patients were treated at a blood flow rate of ≥220 mL/min, whereas at least half of the offline HDF patients were treated at a blood flow rate of <220 mL/min. The mean blood flow rate was a little higher in predilution in online HDF but it was higher in postdilution in offline HDF.
Table 43

Patient distribution on online/offline HDF by blood flow rate and dilution mode

HDF method

100~

120~

140~

160~

180~

200~

220~

240~

260~

280~

300~

350~

400~

Subtotal

Unknown

Total

Mean

S.D.

On-line HDF

Predilution

21

47

782

309

1752

9277

4802

7148

856

813

2133

313

178

28,431

352

28,783

228.2

41.0

(%)

(0.1)

(0.2)

(2.8)

(1.1)

(6.2)

(32.6)

(16.9)

(25.1)

(3.0)

(2.9)

(7.5)

(1.1)

(0.6)

(100.0)

    

Postdilution

0

3

52

33

136

434

241

274

37

38

60

7

4

1319

7

1326

219.9

39.1

(%)

(0.0)

(0.2)

(3.9)

(2.5)

(10.3)

(32.9)

(18.3)

(20.8)

(2.8)

(2.9)

(4.5)

(0.5)

(0.3)

(100.0)

    

Off-line HDF

Predilution

3

8

63

23

71

258

84

98

2

4

15

2

0

631

3

634

204.5

36.0

(%)

(0.5)

(1.3)

(10.0)

(3.6)

(11.3)

(40.9)

(13.3)

(15.5)

(0.3)

(0.6)

(2.4)

(0.3)

(0.0)

(100.0)

    

Postdilution

6

17

205

96

484

1712

686

648

97

82

117

9

6

4165

29

4194

212.1

35.0

(%)

(0.1)

(0.4)

(4.9)

(2.3)

(11.6)

(41.1)

(16.5)

(15.6)

(2.3)

(2.0)

(2.8)

(0.2)

(0.1)

(100.0)

    

Values in parentheses under each figure represent the percentage relative to the subtotal in each row.

HDF hemodiafiltration

Table 44 shows the distributions of dialysis session time in each HDF modality. The dialysis time per session was independent of the HDF method and dilution mode. Many HDF patients tended to undergo HDF for 4.0–4.5 h per session.
Table 44

Patient distribution on online/offline HDF, by dialysis time & dilution mode

HDF method

<3.0

3.0~

3.5~

4.0~

4.5~

5.0~

5.5~

6.0~

Subtotal

Unknown

Total

Mean

S.D.

On-line HDF

Predilution

55

1512

1764

18,954

2900

2980

181

267

28,613

170

28,783

4.11

0.50

(%)

(0.2)

(5.3)

(6.2)

(66.2)

(10.1)

(10.4)

(0.6)

(0.9)

(100.0)

    

Postdilution

1

108

100

858

126

112

7

7

1319

7

1326

4.04

0.50

(%)

(0.1)

(8.2)

(7.6)

(65.0)

(9.6)

(8.5)

(0.5)

(0.5)

(100.0)

    

Off-line HDF

Predilution

4

74

20

433

42

53

0

6

632

2

634

4.00

0.57

(%)

(0.6)

(11.7)

(3.2)

(68.5)

(6.6)

(8.4)

(0.0)

(0.9)

(100.0)

    

Postdilution

5

214

198

2822

396

483

22

35

4175

19

4194

4.12

0.51

(%)

(0.1)

(5.1)

(4.7)

(67.6)

(9.5)

(11.6)

(0.5)

(0.8)

(100.0)

    

Values in parentheses under each figure represent the percentage relative to the subtotal in each row

HDF hemodiafiltration

Comparison between in-center HD and HDF patients

Characteristics of the patients treated by in-center HD and HDF were compared by dilution mode (Table 45). The patients with dialysis vintage of ≥2 years and treated on 3 times per week dialysis program were included to the comparison. The mean age of the in-center HD patients was the highest, whereas the online HDF patients were younger than the patients who underwent other types of dialysis. The dialysis vintage was the shortest in the in-center HD patients and the longest in the offline HDF patients. The postdialysis body weight and percentile creatinine generation rate (%CGR), which is an index of muscle mass, were high in the online HDF patients. CRP was low in the online HDF patients. The indices related to mineral and bone disorder on chronic kidney disease (CKD-MBD) and Hb showed no remarkable differences between the modalities.
Table 45

Comparison of characteristics between in-center HD and HDF patients by dilution mode

  

In-center HD

On-line HDF

Off-line HDF

Predilution

Postdillution

Predilution

Postdillution

Basic indices

Number of patients

228,971

28,783

1326

634

4194

Male

147,033

18,463

824

394

2473

Male (%)

64.2

64.1

62.1

62.1

59.0

Percentage of diabetes

39.5

33.5

30.8

30.1

30.0

Age

68.1 ± 12.3

64.6 ± 12.5

64.8 ± 12.2

66.8 ± 12.1

65.7 ± 11.9

Dialysis vintage (years)

7.0 ± 7.0

9.5 ± 8.5

11.0 ± 9.3

12.0 ± 9.8

12.9 ± 10.0

Postdialysis body weight (male)

59.6 ± 12.2

61.7 ± 12.4

61.0 ± 12.3

58.2 ± 11.5

60.2 ± 12.5

Postdialysis body weight (female)

48.6 ± 10.6

49.2 ± 10.3

48.8 ± 10.1

47.3 ± 9.6

47.4 ± 9.5

Indices for urea kinetics

dilalysis time (minute)

238.4 ± 31.4

246.8 ± 30.2

242.4 ± 29.7

240.3 ± 34.2

247.4 ± 30.4

Blood flow rate (mL/min)

204.9 ± 36.4

228.2 ± 41.0

219.9 ± 39.1

204.5 ± 36.0

212.2 ± 35.0

Kt/V (male)*

1.40 ± 0.26

1.45 ± 0.27

1.45 ± 0.26

1.39 ± 0.25

1.45 ± 0.26

Kt/V (female)*

1.62 ± 0.31

1.71 ± 0.31

1.70 ± 0.31

1.60 ± 0.32

1.69 ± 0.31

normalized protein catablic rate (g/kg/day, male)*

0.85 ± 0.17

0.87 ± 0.16

0.87 ± 0.16

0.86 ± 0.16

0.87 ± 0.17

normalized protein catablic rate (g/kg/day, female)*

0.88 ± 0.18

0.91 ± 0.18

0.91 ± 0.17

0.89 ± 0.17

0.90 ± 0.18

Indices for nutrition

Serum albumin (g/dL)

3.60 ± 0.44

3.65 ± 0.37

3.60 ± 0.41

3.52 ± 0.45

3.57 ± 0.43

Serum CRP level (mg/dL)

0.64 ± 1.94

0.49 ± 1.47

0.56 ± 1.79

0.83 ± 2.46

0.74 ± 2.09

Predialysis serum creatinin (male)*

10.98 ± 2.80

11.51 ± 2.66

11.53 ± 2.74

11.13 ± 2.81

11.10 ± 2.75

Predialysis serum creatinin (female)*

9.12 ± 2.34

9.66 ± 2.12

9.66 ± 2.11

9.16 ± 2.24

9.16 ± 2.13

Percent creatinin generation rate*

98.74 ± 25.96

102.74 ± 23.46

103.17 ± 24.13

96.86 ± 24.72

99.04 ± 24.60

Indices for CKD-MBD

Predialysis serum calcium (mg/dl)

9.18 ± 0.74

9.17 ± 0.73

9.25 ± 0.75

9.34 ± 0.80

9.29 ± 0.82

Predialysis serum phosphorus (mg/dl)

5.20 ± 1.43

5.38 ± 1.42

5.31 ± 1.37

5.29 ± 1.51

5.28 ± 1.51

Intact PTH level (pg/ml)

170.0 ± 161.0

178.1 ± 168.9

176.1 ± 157.7

178.5 ± 212.1

168.6 ± 163.9

Predialysis serum total cholesterol (mg/dl)

154.7 ± 35.3

158.39 ± 35.55

162.50 ± 36.07

152.4 ± 36.0

154.9 ± 35.7

Indices for anemia

Predialysis hemoglobin (g/dL)

10.69 ± 1.28

10.88 ± 1.24

10.80 ± 1.24

10.78 ± 1.51

10.68 ± 1.36

Note: Total number of each index was different from each other because response rate for the question was different in each other

HD hemodilaysis, HDF hemodiafiltration, CKD-MBD chronic kidney disease-mineral & bone disorder

*For the indices from age to predialysis Hb concentration, “mean ± S.D.” are shown

Chapter 4: Current status of peritoneal dialysis

The results of the facility survey shown in Table 1 revealed that the prevalent PD patient count was 9255 at the end of 2014. Moreover, the number of patients who had a PD catheter but were supposed to use it only for peritoneal lavage was 278. The number of patients who started PD in 2014 but stopped PD and introduced to another method during 2014 was 193. The detailed results of the PD survey are reported separately. Therefore, only a basic summary of the results is included in this report.

Combination therapy of PD and other dialysis modalities

Prevalent patient distributions on the combination of PD and other dialysis modalities (PD + HD) were summarized in Table 46. The main dialysis methods are categorized on the basis of the classification codes for dialysis methods that have been conventionally used in the patient survey. Among the 310,086 patients who responded to questions regarding the status of PD + HD in the patient survey, 301,063 (97.1%) underwent a non-PD dialysis modalities such as HD (non-PD patients) and 9023 (2.9%) underwent PD alone or PD + HD. The count of non-PD patients increased from 2013 as 297,773, whereas that of PD patients decreased by 98 from 2013 as 9121.
Table 46

Patient distribution by modality and combination of PD

 

Main dialysis methodsa

 

In-center HD

HDF

Hemo-filtration

Hemo-adsorption

Home HD

PD

Total

(%)

(%)

Combined use of PD and another modality

Patients who did not undergo PD (Non-PD patients)

Non-PD + non-catheter patients

255,316

43,239

91

1630

518

0

300,794

(99.9)

(97.0)

(%)

(84.9)

(14.4)

(0.0)

(0.5)

(0.2)

(0.0)

(100.0)

  

Non-PD + catheter patientsb

245

22

1

0

1

0

269

(0.1)

(0.1)

(%)

(91.1)

(8.2)

(0.4)

(0.0)

(0.4)

(0.0)

(100.0)

  

Total number of non-PD patients

255,561

43,261

92

1630

519

0

301,063

(100.0)

(97.1)

(%)

(84.9)

(14.4)

(0.0)

(0.5)

(0.2)

(0.0)

(100.0)

  

Patients who underwent PD (PD patients)c

PD only

0

0

0

0

0

7188

7188

(79.7)

(2.3)

(%)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

(100.0)

(100.0)

  

Patients who underwent PD and another modality (PD + HD patients)

PD + HD 1/week

0

0

0

0

0

1544

1544

(17.1)

(0.5)

(%)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

(100.0)

(100.0)

  

PD + HD 2/week

28

8

0

0

0

141

177

(2.0)

(0.1)

(%)

(15.8)

(4.5)

(0.0)

(0.0)

(0.0)

(79.7)

(100.0)

  

PD + HD 3/week

29

10

0

0

1

0

40

(0.4)

(0.0)

(%)

(72.5)

(25.0)

(0.0)

(0.0)

(2.5)

(0.0)

(100.0)

  

PD + HD 4/week

1

0

0

0

0

0

1

(0.0)

(0.0)

(%)

(100.0)

(0.0)

(0.0)

(0.0)

(0.0)

(0.0)

(100.0)

  

PD + HD other frequencies

8

2

0

0

0

63

73

(0.8)

(0.0)

(%)

(11.0)

(2.7)

(0.0)

(0.0)

(0.0)

(86.3)

(100.0)

  

Total PD + HD patients

66

20

0

0

1

1748

1835

(20.3)

(0.6)

(%)

(3.6)

(1.1)

(0.0)

(0.0)

(0.1)

(95.3)

(100.0)

  

Total number of PD patients

66

20

0

0

1

8936

9023

(100.0)

(2.9)

(%)

(0.7)

(0.2)

(0.0)

(0.0)

(0.0)

(99.0)

(100.0)

  

Total number of non-PD and PD patients

255,627

43,281

92

1630

520

8936

310,086

 

(100.0)

(%)

(82.4)

(14.0)

(0.0)

(0.5)

(0.2)

(2.9)

(100.0)

  

Unspecified

14

2

0

0

1

5

22

  

(%)

(63.6)

(9.1)

(0.0)

(0.0)

(4.5)

(22.7)

(100.0)

  

No information available

0

0

0

0

0

0

0

  

(%)

  

Total

255,641

43,283

92

1630

521

8941

310,108

  

(%)

(82.4)

(14.0)

(0.0)

(0.5)

(0.2)

(2.9)

(100.0)

  

Note: The selection of the classification code for the dialysis method of the patients classified in the shaded area in the table, i.e., PD + HD patients, was left to the subjective decision of the respondents

HD hemodialysis, HDF hemodiafiltration, PD peritoneal dialysis

aMain dialysis methods are classified on the basis of the classification codes for dialysis methods that have conventionally been used in the annual survey

bIn this survey, patients who did not undergo PD despite having a peritoneal catheter for PD (including those who underwent only peritoneal lavage) were tentatively classified as patients who did not undergo PD (i.e., non-PD patients) to analyze the survey data. It is not intended to standardize the above definition

cIn this survey, both patients who underwent PD only and those who underwent PD and another method were tentatively classified as patients who underwent PD (i.e., PD patients) to analyze the survey data. It is not intended to standardize the above definition

Among the 301,063 of non-PD patients, 269 patients had a PD catheter (i.e., non-PD + catheter patients). Most of these patients were switched to HD from PD but did not have their PD catheter removed. There was also one non-PD + catheter patient among the 519 patients who underwent home HD. In this survey report, non-PD + catheter patients were tentatively classified and counted as patients who did not undergo PD in the analysis of the survey data. Note that this is only a tentative classification and that the Committee of Renal Data Registry (CRDR) of JSDT does not intend to standardize the above definition.

The count of PD-only patients was 7188, which was smaller than that in 2013 as 7324. The percentage of PD-only patients in all 9023 PD patients was 79.7%, which was smaller than that in 2013 as 80.3%. Moreover, the number of patients of PD + HD was 1835, which was larger than that in 2013 as 1797. The percentage of PD + HD patients in the entire PD patient population was 20.3%, which was larger than that in 2013 as 19.7%.

Among 1835 PD + HD patients, 1544 (84.1%) underwent a non-PD dialysis modality once a week, 177 (9.6%) in twice a week, 40 (2.2%) in three times a week, and one patient in four times a week. There were also 73 patients (4.0%) of PD + HD at frequencies other than those mentioned above.

There were various main dialysis method codes in 1835 PD + HD patients (shaded area in Table 46) because the choice of a code for the main dialysis method was just dependent on the responder’s decision.

This classification of the main dialysis modality for the PD + HD patients have been a tentative one by CRDR, a standardized classification for the PD + HD patients had not been established.

PD + HD and PD vintage

Table 47 shows the prevalent patient distribution by PD + HD and PD vintage. The responses for both the PD vintage and the status of PD + HD were recovered in 5678 PD + HD patients. The percentage of PD + HD patients even with a PD vintage of <1 year was 3.3% and increased with PD vintage: ≥1–<2 years, 10.1%; ≥2–<4 years, 16.3%; ≥4–<6 years, 26.9%; ≥6–<8 years, 40.9%; ≥8–<10 years, 53.5%; and ≥10 years, 58.7%. The majority (82.8%) of the PD + HD patients underwent HD or HDF once a week.
Table 47

PD patient distribution by PD vintage and PD combination

Combined use of PD and another method

<1 yr.

1 yr. ~

2 yrs. ~

4 yrs. ~

6 yrs. ~

8 yrs. ~

10 yrs. ~

Subtotal

No information available

Total

Mean

S.D.

PD only

1252

948

1269

640

269

101

109

4588

2600

7188

2.80

2.72

(%)

(96.7)

(89.8)

(83.6)

(73.1)

(59.1)

(46.5)

(41.3)

(80.8)

(77.8)

(79.7)

  

PD + HD 1/week

35

93

219

205

151

86

113

902

642

1544

5.69

3.92

(%)

(2.7)

(8.8)

(14.4)

(23.4)

(33.2)

(39.6)

(42.8)

(15.9)

(19.2)

(17.1)

  

PD + HD 2/week

4

7

12

20

27

26

26

122

55

177

7.53

4.15

(%)

(0.3)

(0.7)

(0.8)

(2.3)

(5.9)

(12.0)

(9.8)

(2.1)

(1.6)

(2.0)

  

PD + HD 3/week

 

3

3

2

2

 

5

15

25

40

6.58

5.05

(%)

 

(0.3)

(0.2)

(0.2)

(0.4)

 

(1.9)

(0.3)

(0.7)

(0.4)

  

PD + HD other frequencies

4

4

14

8

6

4

11

51

22

73

6.47

4.99

(%)

(0.3)

(0.4)

(0.9)

(0.9)

(1.3)

(1.8)

(4.2)

(0.9)

(0.7)

(0.8)

  

Total

1295

1055

1517

875

455

217

264

5678

3344

9022

3.40

3.27

(%)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

(100.0)

  

Values in parentheses under each figure represent the percentage relative to the total in each column

Tabulation target: PD patients (including those who underwent PD and HD or HDF)

HD hemodialysis, PD peritoneal dialysis

Abbreviations

AFBF: 

Acetate free biofiltration

APD: 

Automated peritoneal dialysis

BUN: 

Blood urea nitrogen

CRDR: 

The Committee of Renal Data Registry of the Japanese Society for Dialysis Therapy

ESKD: 

End-stage kidney disease

ETRF: 

Endotoxin retentive filter

HD: 

Hemodialysis

HDF: 

Hemodiafiltration

JRDR: 

JSDT renal data registry

JSDT: 

The Japanese Society for Dialysis Therapy

Kt/V: 

Index for standardized dialysis dose defined as

PD: 

Peritoneal dialysis

PIH: 

Pregnancy-induced hypertension

PKD: 

Polycystic kidney disease

Pmp: 

Per million population

RPGN: 

Rapidly progressive glomerulonephritis

TVC: 

Total viable microbial count

UF: 

Ultrafiltration

USB: 

Universal serial bus

Declarations

Acknowledgements

We owe the completion of this survey to the efforts of the members of the subcommittee of the local cooperation mentioned as follows and the staff members of dialysis facilities who participated in the survey and responded to the questionnaires. We would like to express our deepest gratitude to all these people.

District Cooperative Committee: Noritomo Itami, Tetsuya Kawata, Chikara Oyama, Koji Seino, Toshinobu Sato, Shigeru Sato, Minoru Ito, Masaaki Nakayama, Atsushi Ueda, Takashi Yagisawa, Tetsuo Ando, Tomonari Ogawa, Hiroo Kumagai, Makoto Ogura, Takahiro Mochizuki, Ryoichi Ando, Kazuyoshi Okada, Tetsuya Kashiwagi, Chieko Hamada, Yugo Shibagaki, Nobuhito Hirawa, Junichiro Kazama, Yoichi Ishida, Hitoshi Yokoyama, Ryoichi Miyazaki, Mizuya Fukasawa, Masaki Nagasawa, Teppei Matsuoka, Akihiko Kato, Noriko Mori, Yasuhiko Ito, Hirotake Kasuga, Sukenari Koyabu, Takashi Udu, Tetsuya Hashimoto, Masaaki Inaba, Terumasa Hayashi, Tomoyuki Yamakawa, Shinichi Nishi, Akira Fujimori, Tatsuo Yoneda, Shigeo Negi, Akihisa Nakaoka, Takafumi Ito, Hitoshi Sugiyama, Takao Masaki, Yutaka Nitta, Hirofumi Hashimoto, Masato Yamanaka, Masaharu Kan, Kazumichi Ota, Masahito Tamura, Koji Mitsuiki, Yuji Ikeda, Masaharu Nishikido, Akira Miyata, Tadashi Tomo, Shoichi Fujimoto, Tsuyoshi Nosaki, Yoshinori Oshiro.

Funding

There are no funding for the current study.

All efforts and costs for the 2014 JRDR survey and making the report were totally given by JSDT.

Availability of data and materials

When anyone want to use the data and materials from the current manuscript without modifications, all data and materials are freely available with stating “data from JSDT”.

When anyone want to use the data and materials from the current manuscript with modifications, any re-calculations or something, they have to state the following sentence in their publication. “The data reported here have been provided by the Japanese Society for Dialysis Therapy (JSDT). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the JSDT.”

Authors’ contributions

IM was the director of CRDR in 2014 and directed all of the 2014 JRDR survey. IM and SN finalized the results of the survey and made this manuscript. SO and AW designed the survey sheets and made a special program mounted in MS Excel worksheet for the convenience of self-assessment for the dialysis quality of each dialysis facility. SN, NK, and TH had the responsibilities on the data analysis. KW had the responsibility on the ethical aspect of the JRDR survey. KN was the president of JSDT in 2014, and checked all the results from the 2014 JRDR survey, and approved them to be published. All authors read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The JSDT registry was approved by the ethical committee of JSDT, the approval no. is 1.

The aims of JSDT Renal Data Registry (JRDR) were well explained for the participated dialysis patients through the dialysis facilities.

It does not always need to get the documented approval form from the patients because all the collected data were the existing ones and there were no new interventions.

The original data had been totally anonymized so there are no risks for deteriorating the privacy of the dialysis facilities and the patients.

The data presented in the current manuscript does not contain any images, videos, or voice recording which might have a risk for identifying an individual.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
(2)
Department of Nephrology, Yabuki Hospital, 4-4-5 Shima Kita, Yamagata Yamagata, 990-0885, Japan

References

  1. Nakai S. The history of Japanese Society for Dialysis Therapy Registry. J Jpn Soc Dial Ther. 2010;43(2):119–52 (In Japanese).View ArticleGoogle Scholar
  2. Masakane I, Nakai S, Ogata S, Kimata N, Hanafusa N, Hamano T, Wakai K, Wada A, Nitta K. An overview of regular dialysis treatment in Japan (as of 31 December 2013). Ther Apher Dial. 2015;19(6):540–74.View ArticlePubMedGoogle Scholar
  3. Japanese society for dialysis therapy. Overview of Regular Dialysis Treatment in Japan, the CD-ROM Report (as of 31 December 2014). Tokyo: Japanese society for dialysis therapy; 2015. In Japanese.Google Scholar
  4. Cutler SJ, Ederer F. Maximum utilization of the life table method in analyzing survival. J Chron Dis. 1958;8:699–712.View ArticlePubMedGoogle Scholar
  5. Nakai S, Wakai K, Yamagata K, Iseki K, Tsubakihara Y. Prediction of dialysis patients in Japan: based on Japanese Society for Dialysis Therapy Registry. J Jpn Soc Dial Ther. 2012;45(7):599–613 (In Japanese).View ArticleGoogle Scholar
  6. Nakai S, Iseki K, Itami N, Ogata S, Kazama JJ, Kimata N, Shigematsu T, Shinoda T, Shoji T, Suzuki K, Taniguchi M, Tsuchida K, Nakamoto H, Nishi H, Hashimoto S, Hasegawa T, Hanafusa N, Hamano T, Fujii N, Masakane I, Marubayashi S, Morita O, Yamagata K, Wakai K, Wada A, Watanabe Y, Tsubakihara Y. An overview of regular dialysis treatment in Japan (as of 31 December 2010). Ther Apher Dial. 2012;16(6):483–521.View ArticlePubMedGoogle Scholar
  7. Kawanishi H, Akiba T, Masakane I, Tomo T, Mineshima M, Kawasaki T, Hirakata H, Akizawa T. Standard on microbiological management of fluids for hemodialysis and related therapies by the Japanese Society for Dialysis Therapy 2008. Ther Apher Dial. 2009;13:161–6.View ArticlePubMedGoogle Scholar
  8. Ministry of health, labour and welfare. About the medical insurance system revision in 2010. (http://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken12/dl/index-062.pdf, searched in September, 2016. Accessed 1 Nov 2015.
  9. Ministry of health, labour and welfare. About the medical insurance system revision in 2012. (http://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken15/dl/gaiyou.pdf, searched in September, 2016. Accessed 1 Nov 2015.
  10. Nakai S, Masakane I, Akiba T, Shigematsu T, Yamagata K, Watanabe Y, Iseki K, Itami N, Shinoda T, Morozumi K, Shoji T, Marubayashi S, Morita O, Kimata N, Shoji T, Suzuki K, Tsuchida K, Nakamoto H, Hamano T, Yamashita A, Wakai K, Wada A, Tsubakihara Y. Overview of regular dialysis treatment in Japan as of 31 December 2006. Ther Apher Dial. 2008;12(6):428–56.View ArticlePubMedGoogle Scholar
  11. Nakai S, Masakane I, Shigematsu T, Hamano T, Yamagata K, Watanabe Y, Itami N, Ogata S, Kimata N, Shinoda T, Syouji T, Suzuki K, Taniguchi M, Tsuchida K, Nakamoto H, Nishi S, Nishi H, Hashimoto S, Hasegawa T, Hanafusa N, Fujii N, Marubayashi S, Morita O, Wakai K, Wada A, Iseki K, Tsubakihara Y. An overview of regular dialysis treatment in Japan (as of 31 December 2007). Ther Apher Dial. 2009;13(6):457–504.View ArticlePubMedGoogle Scholar
  12. Nakai S, Suzuki K, Masakane I, Wada A, Itami N, Ogata S, Kimata N, Shigematsu T, Shinoda T, Syouji T, Taniguchi M, Tsuchida K, Nakamoto H, Nishi S, Nishi H, Hashimoto S, Hasegawa T, Hanafusa N, Hamano T, Fujii N, Marubayashi S, Morita O, Yamagata K, Wakai K, Watanabe Y, Iseki K, Tsubakihara Y. Overview of regular dialysis treatment in Japan (as of 31 December 2008). Ther Apher Dial. 2010;14(6):505–40.View ArticlePubMedGoogle Scholar
  13. Nakai S, Iseki K, Itami N, Ogata S, Kazama JJ, Kimata N, Shigematsu T, Shinoda T, Shoji T, Suzuki K, Taniguchi M, Tsuchida K, Nakamoto H, Nishi H, Hashimoto S, Hasegawa T, Hanafusa N, Hamano T, Fujii N, Masakane I, Marubayashi S, Morita O, Yamagata K, Wakai K, Wada A, Watanabe Y, Tsubakihara Y. Overview of regular dialysis treatment in Japan (as of 31 December 2009). Ther Apher Dial. 2012;16(1):11–53.View ArticlePubMedGoogle Scholar
  14. Nakai S, Watanabe Y, Masakane I, Wada A, Shoji T, Hasegawa T, Nakamoto H, Yamagata K, Kazama JJ, Fujii N, Itami N, Shinoda T, Shigematsu T, Marubayashi S, Morita O, Hashimoto S, Suzuki K, Kimata N, Hanafusa N, Wakai K, Hamano T, Ogata S, Tsuchida K, Taniguchi M, Nishi H, Iseki K, Tsubakihara Y. Overview of regular dialysis treatment in Japan (as of 31 December 2011). Ther Apher Dial. 2013;17(6):567–611.View ArticlePubMedGoogle Scholar
  15. Nakai S, Hanafusa N, Masakane I, Taniguchi M, Hamano T, Shoji T, Hasegawa T, Itami N, Yamagata K, Shinoda T, Kazama JJ, Watanabe Y, Shigematsu T, Marubayashi S, Morita O, Wada A, Hashimoto S, Suzuki K, Nakamoto H, Kimata N, Wakai K, Fujii N, Ogata S, Tsuchida K, Nishi H, Iseki K, Tsubakihara Y. An overview of regular dialysis treatment in Japan (as of 31 December 2012). Ther Apher Dial. 2014;18(6):535–602.View ArticlePubMedGoogle Scholar
  16. Kawanishi H, Mineshima M, Takezawa S, Masakane I, Minakuti J, Akizawa T, Saito A. New standard on microbiological management of dialysate and classification of dialyzers. J Jpn Soc Dial Ther. 2005;38(2):149–54 (In Japanese).View ArticleGoogle Scholar

Copyright

Advertisement