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Annual Dialysis Data Report 2015, JSDT Renal Data Registry

  • Ikuto Masakane1Email author,
  • Masatomo Taniguchi1,
  • Shigeru Nakai1,
  • Kenji Tsuchida1,
  • Shunsuke Goto1,
  • Atsushi Wada1,
  • Satoshi Ogata1,
  • Takeshi Hasegawa1,
  • Takayuki Hamano1,
  • Norio Hanafusa1,
  • Junichi Hoshino1,
  • Jun Minakuchi1,
  • Hidetomo Nakamoto1 and
  • on behalf of the Japanese Society for Dialysis Therapy Renal Data Registry Committee
Renal Replacement Therapy20184:19

https://doi.org/10.1186/s41100-018-0149-8

Received: 2 December 2017

Accepted: 23 January 2018

Published: 28 March 2018

Abstracts

The annual survey of Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) was conducted for 4380 dialysis facilities at the end of 2015, among which 4321 facilities (98.7%) responded. The response rate of the 2015 survey was comparable with the past, even though it was the first year after the new anonymization method. The number of chronic dialysis patients in Japan continues to increase every year; it has reached 324,986 at the end of 2015. The mean age was 67.86 years. At the end of 2015, the prevalence rate was 2592 patients per million population. Diabetic nephropathy was the most common primary disease among the prevalent dialysis patients (38.4%), followed by chronic glomerulonephritis (29.8%) and nephrosclerosis (9.5%). The rate of diabetic nephropathy and nephrosclerosis has been increasing year by year, whereas that of chronic glomerulonephritis was declining. The number of incident dialysis patients during 2015 was 39,462; it has remained stable since 2008. The average age was 69.20 years, and diabetic nephropathy (43.7%) was the most common cause in the incident dialysis patients. These patients caused by diabetes did not change in number for the last several years. Meanwhile, 31,608 patients died in 2015; the crude mortality rate was 9.6%. The patients treated by hemodiafiltration (HDF) have been increasing rapidly from the revision of medical reimbursement for HDF therapy in 2012. It has attained 53,776 patients at the end of 2015, which were 10,493 greater than that in 2014. In particular, the number of online HDF patients increased about ten times 2012. The number of peritoneal dialysis (PD) patients was 9322 in 2015, which was slightly increased than 2014. Twenty percent of PD patients treated in the combination of hemodialysis (HD) or HDF therapy. Five hundred seventy-two patients underwent home HD therapy at the end of 2015; it increased by 43 from 2014.

Further JRDR data analyses could clarify the relationships between various dialysis modalities, patient care, and clinical outcomes; furthermore, it could also make it possible to establish clinical practice guidelines or medical reimbursement revisions based on the evidence.

Trial registration

JRDR was approved by the ethical committee of JSDT and has been registered in the “University hospital Medical Information Network (UMIN) Clinical Trials Registry” as an approved number of UMIN000018641 since 2015.

Keywords

Elder dialysis patientsDiabetic nephropathyUltrapure dialysis fluidOnline hemodiafiltrationCombination of PD and HD

Part I. JRDR 2015 Annual Data Report; General Remarks

Introduction

Japanese Society for Dialysis Therapy (JSDT) has conducted a survey (JSDT Renal Data Registry: JRDR) on the status of chronic dialysis therapy in Japan at the end of every year since 1968, covering almost all dialysis facilities throughout the country [1, 2]. Despite the fact that this survey is conducted without providing any compensation to participating facilities, its response rate represents a largely complete and unbiased survey of the status of chronic dialysis in Japan, making it quite rare in the world. In publishing our results, we would like to take this opportunity to express our sincere gratitude to everyone at the participating dialysis facilities for taking part in the survey in addition to their routine clinical practice.

JRDR had previously featured two types of reports: prompt (unfixed) data reported at the annual meeting held every June and defined (fixed) data wherein previous data were subsequently screened. The prompt data were distributed at the annual meeting in “An Overview of Regular Dialysis Treatment in Japan, the Illustrated Report”. The defined data are presented in “An Overview of Regular Dialysis Treatment in Japan, the CD-ROM Report” and were distributed at the end of the year to all facilities that were JSDT members or participated in the survey. The annual JRDR report, which was published every January in the Journal of Japanese Society for Dialysis (in Japanese), also consists of the defined data. In various cases, the prompt data from the illustrated report were overwhelmingly cited by numbers. The decade of the 2010s has been predicted to include a reduction in the pace of increase in the number of dialysis patients, reaching the point where this number would decrease within a few years [3]. This meant that sometimes defined data would indicate that the rate was still increasing even if it had decreased in the prompt data, which could cause serious confusion. Thus, the use of prompt data for the illustrated reports was discontinued in the 2014 survey, and the illustrated report and CD-ROM were prepared from the defined data instead [4]. The illustrated report is now distributed at the end of the year to each dialysis facility with the CD-ROM included in its back cover.

In December 2014, the Ethical Guidelines for Medical and Health Research Involving Human Subjects was issued by the Ministry of Health, Labour, and Welfare and the Ministry of Education, Culture, Sports, Science, and Technology, demanding that all academic societies strictly follow ethical considerations and protect personal information in epidemiological research [5]. Even JSDT changed its survey methods based on these guidelines, starting with enhanced anonymization from its 2015 year-end survey to ensure the protection of personal information. The specific changes made to their survey methods can be found on the members-only pages of the JSDT homepage (http: //www.jsdt.or.jp/). Furthermore, all survey methods were reviewed in March 2015 by the ethics committee (JSDT Ethics Committee Approval No. 1) to uphold ethical validity, fairness, and transparency of surveys. The reviewed survey methods were then entered into the UMIN Clinical Trials Registry (UMIN-CTR) for availability to the public (UMIN000018641), and the review results were batched together for posting on the JSDT homepage. Enhanced anonymization consisted of a system wherein patient information was converted into a random string of alphanumeric characters using a special algorithm, and the correspondence tables for retrieving the real names of patients were held by each dialysis facility; hence, even the JSDT headquarters could not retrieve patient information. The 2015 year-end survey represented the first year of complete anonymization using this system, and although participating facilities were asked to handle more work than usual, the response rate was almost same as in other years. We were reminded of the sincere attitude towards dialysis treatment of all those involved in dialysis treatment in Japan, as well as their trust and expectations towards JSDT.

Survey methods

Sending and collecting questionnaires

The JRDR survey is performed by two types of questionnaires: facility questionnaires that include questions, such as the number of dialysis beds, staff, and patients, and patient questionnaires that include questions, such as dialysis prescriptions, laboratory findings, and outcome indices of individual dialysis patients. In the 2015 year-end JRDR survey, two USBs were mailed to dialysis facilities nationwide in December 2015. One USB contained facility and patient questionnaires prepared in MS Excel, whereas the other USB contained the correspondence tables needed to anonymize patient information and recover real names. The patient questionnaires contained patient information recorded in previous years using the anonymization methods, which were then updated by dialysis facilities to include data on patient survival, death, transfers, and other outcomes. Furthermore, new patients were registered, and the correspondence table USB was used to anonymize the information once all patients were entered. Once anonymized, patient information on questionnaires including their name, sex, and date of birth were converted into a string of alphanumeric characters of random fixed length. Subsequently, each dialysis facility only returned the questionnaire USB to the JSDT administrative offices after confirming that patient personal information was completely anonymized. As described above, anonymization was enhanced with the 2015 JRDR survey, abolishing the paper-based survey methods used before 2014. Paper-based surveys are now only used for certain facilities. The initial deadline was January 31, 2016, but facilities that had not responded were urged to participate, and they were eventually incorporated into the 2015 year-end data with a June 30 deadline.

Survey items

The following items were asked in the 2015 JRDR survey. As described above, the 2015 survey was the first after enhanced anonymization; hence, new topical survey items were not incorporated, and the contents were similar to the 2014 year-end survey. In addition, all survey items before 2014 are included on the member pages of the JSDT homepage (http: //www.jsdt.or.jp/)).
  • Facility survey
    1. 1.
      Overview and scope of facilities
      • Name and contact numbers (TEL, FAX) of facility, as well as the year and month when the facility started providing dialysis treatment

      • Dialysis capabilities: Capacity for simultaneous hemodialysis (HD) treatments, maximum capacity for HD treatments, and number of bedside consoles

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

      • Number of medical dialysis specialists qualified by JSDT

       
    2. 2.
      Patient dynamics
      • Number of prevalent dialysis patients at the end of 2015 (number of patients by treatment modality, inpatient/outpatient)

      • Number of dialysis patients undergoing nighttime dialysis in 2015

      • Number of incident dialysis patients in 2015 (number of incident HDF and peritoneal dialysis (PD) patients)

      • Number of deceased patients during 2015

       
    3. 3.
      Dialysis fluid quality control
      • Use of endotoxin retentive filter (ETRF)

      • Dialysis fluid sampling status and sampling site of dialysis fluid during testing

      • Frequency for measuring endotoxin (ET) concentration in dialysis fluid and ET concentration in dialysis fluid

      • Frequency for measuring total viable microbial count (TVC) in dialysis fluid, sampling volume for TVC, cultivation medium for TVC, and TVC in dialysis fluid

       
  • Patient survey
    1. 1.
      Patient personal information
      • Sex, date of birth, year and month of start of dialysis, year and month of transfer from another hospital, primary disease, residence (prefecture), dialysis modality, month of transfer (destination facility code), outcome category, outcome date (transfer, death, dropout, or transplantation) (destination facility code), month of death, cause of death, dates of changes, change codes, status of combined therapies involving PD with HD or hemodiafiltration (HDF), etc., PD experience, and number of kidney transplants

       
    2. 2.
      HD/HDF therapy conditions
      • Frequency of dialysis session per week, dialysis time per session, and blood flow rate

      • HDF: dilution methods, substitution fluid volume per session

      • Body height, pre- and post-dialysis body weight, pre-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, and pre-dialysis pulse rate

       
    3. 3.
      Laboratory findings
      • Pre- and post-dialysis serum urea nitrogen (UN), pre- and post-dialysis serum creatinine concentration, pre-dialysis serum albumin concentration, pre-dialysis serum C-reactive protein (CRP) concentration, pre-dialysis serum calcium concentration, pre-dialysis serum phosphorus concentration, serum parathyroid hormone (PTH) assay method, PTH level (intact or whole PTH), pre-dialysis hemoglobin concentration, serum total cholesterol concentration (total cholesterol), and serum high-density lipoprotein cholesterol concentration (HDL-C)

       
    4. 4.
      Outcome factors
      • Antihypertensive drug use, smoking, history of diabetes, history of myocardial infarction, history of cerebral hemorrhage, history of cerebral infarction, limb amputation, history of proximal femur fracture, history of encapsulating peritoneal sclerosis (EPS)

       
    5. 5.
      Peritoneal dialysis (PD) survey
      • Therapeutic history: Current PD dialysis vintage, number of months in which PD was performed in 2015

      • Peritoneal function: Implementation of peritoneal equilibration test (PET), 4-h creatinine concentration dialysate/plasma ratio in PET (PET Cr D/P ratio)

      • Dialysis prescription: Type of PD fluid, volume of PD fluid per day, PD treatment time per day, daily urine volume, mean fluid removal volume per day, Kt/V by residual kidney function (residual kidney Kt/V), Kt/V by PD (PD Kt/V)

      • Dialysis method: Use of automated peritoneal dialysis (APD) machine, changing maneuver of PD fluid

      • Infectious disease: Numbers of peritonitis during 2015 (peritonitis frequency), numbers of exit-site infections during 2015

       

Methods for publicizing survey results and overview of this report

As described in the introduction, JRDR survey results could be reported by preparing an illustrated report and an annual report based on the defined data from the 2014 survey. The annual report was posted every January in the Journal of Japanese Society for Dialysis (in Japanese), and a translated version was posted approximately 6 months later in the Therapeutic Apheresis and Dialysis (TAD). In copies of the TAD, survey results were mostly reported in tables due to page limitations, and the illustrated report provides graphic explanations. The JSDT website makes downloading PDFs of TAD papers and the illustrated reports possible and, furthermore, MS-PowerPoint presentations with illustrations [6], but it was the illustrated reports that overwhelmingly receive the most use in general. In contrast, several foreign countries have been demanding that the results of the JRDR survey be published in a form that people around the world may easily use. In the 2016 business plan, the JRDR Committee proceeded with preparations to make PDFs of English language versions of the annual report, English translations of MS-PowerPoint presentations, and MS Excel files with tables in English available on the JSDT website to let the rest of the world know the state of dialysis therapy in Japan and the expertise available. When this was done, the posting destination was changed from the TAD to the journal Renal Replacement Therapy (RRT), which joined a new English language JSDT journal (now preparing the 2014 year-end survey report). In changing the publication methods for survey results, the form of illustrated, Japanese language, and English language reports had to be streamlined as much as possible to simplify the effort required to prepare reports in Japanese and translate them into English. This report was published by this process, and although it was written, based on tables and drawings used in the illustrated report, the issue of how to maintain uniformity in areas such as the order of recording is still being sorted out. Hence, there might still be some inconvenience for readers, and thus, we apologize. We report the survey results and discussion in “JRDR Annual Data Report (ADR) 2015” in the Part II as described below.

Contents of JRDR 2015 ADR

Chapter 1: Basic demographics
  1. 1.

    Facility dynamics

     
  2. 2.

    Number of dialysis patients

     
  3. 3.

    Distribution of dialysis patients by treatment modality and prefecture

     
  4. 4.

    Mean age, sex, and dialysis vintage

     
  5. 5.

    Primary diseases

     
  6. 6.

    Causes of death

     
  7. 7.

    Crude death rate and survival rate

     
Chapter 2: Current status of dialysis fluid quality management
  1. 1.

    Overview of dialysis fluid quality

     
  2. 2.

    Dialysis fluid ET testing

     
  3. 3.

    Dialysis fluid viable microbial testing

     
  4. 4.

    Present status of ETRF installation

     
  5. 5.

    Overall dialysis fluid quality

     
Chapter 3: Current status of hemodiafiltration (HDF)
  1. 1.

    HDF patient dynamics

     
  2. 2.

    Types and annual changes of HDF treatment modality

     
  3. 3.

    HDF prescriptions

     
  4. 4.

    Urea kinetics, nutrition, and inflammation in HDF patients

     
  5. 5.

    Management for anemia and CKD-MBD in HDF patients

     
Chapter 4: Current status of peritoneal dialysis (PD)
  1. 1.

    PD patient dynamics

     
  2. 2.

    Present status of PD + HDF combined therapy

     
  3. 3.

    PD prescriptions

     
  4. 4.

    Residual kidney function (urine volume and residual kidney Kt/V)

     
  5. 5.

    Peritoneal function (ultrafiltration volume and PD Kt/V)

     
  6. 6.

    Peritoneal equilibration test (PET) and dialysate/plasma creatinine (D/P Cr) ratio

     
  7. 7.

    Exit-site infection (ESI) and peritonitis

     
  8. 8.

    History of encapsulating peritoneal sclerosis (EPS)

     
Chapter 5: Current status of elderly dialysis patients
  1. 1.

    Present status of elderly dialysis patients

     
  2. 2.

    Hemodynamics, dialysis prescriptions and urea kinetics in elderly dialysis patients

     
  3. 3.

    Nutrition and inflammation in elderly dialysis patients

     
  4. 4.

    Management for anemia and CKD-MBD in elderly dialysis patients

     
Chapter 6: Current status of diabetic dialysis patients
  1. 1.

    Present status of diabetic dialysis patients

     
  2. 2.

    Hemodynamics, dialysis prescriptions, and urea kinetics in diabetic dialysis patients

     
  3. 3.

    Nutrition and inflammation in diabetic dialysis patients

     
  4. 4.

    Management for anemia and CKD-MBD in diabetic dialysis patients

     
  5. 5.

    Annual changes in diabetic dialysis patients dynamics

     

Part II. JRDR 2015 Annual Data Report: results and discussion

Chapter 1: Basic demographics

Facility dynamics

The 2015 JRDR survey was conducted at 4380 facilities nationwide, and the 4321 facilities has responded. The number of responding facilities had been increasing over the past 10 years, but a nine-center reduction (0.2 point reduction) from the previous year was observed in the 2015 survey. There was a concern that the enhanced anonymization and the abolition of paper-based survey had resulted in a decreased response rate and an undervaluation of dialysis facility and patient counts. However, the response rate for facility survey was 98.7%, whereas the facility response rate for patient survey was 94.6% of the total; thus, there was hardly any change from the previous year. Thus, a decrease in the number of facilities responding to questionnaires does not necessarily mean a substantial decrease in the number of dialysis facilities. However, recently, the slowing rate of increase in dialysis patients was observed, and thus, future trends have become a matter of attention (Tables 1 and 2). The 4321 facilities had 133,538 bedside consoles (a 1983 increase from the previous year), a simultaneous HD treatment capacity of 131,514, and a maximum capacity for HD treatments of 438,391. Compared with the end of 2014, these represented increases of 1.5, 1.3, and 1.4%, respectively (Table 2).
Table 1

Summary of chronic dialysis therapy in Japan, 2015

Number of facilities

 

4321 facilities

(Decrease of 9 facilities, 0.2% decrease)

Equipment

Number of bedside consoles

133,538 units

(Increase of 1983 units, 1.5% increase)

Capacity

Capacity for simultaneous HD treatments

131,514 treatments

(Increase of 1654 patients, 1.3% increase)

Maximum capacity

438,391 patients

(Increase of 5958 patients, 1.4% increase)

  

Outpatients

Inpatients

Total

Hemodialysis

Hemodialysis (HD)

231,835

(78.5)

26,539

(89.6)

258,374

(79.5)

Hemodiafiltration (HDF)

52,757

(17.9)

2576

(8.7)

55,333

(17.0)

Hemofiltration (HF)

11

(0.0)

6

(0.0)

17

(0.0)

Blood adsorption dialysis

1344

(0.5)

24

(0.1)

1368

(0.4)

Home hemodialysis

569

(0.2)

3

(0.0)

572

(0.2)

Peritoneal dialysis

PD only

7030

(2.4)

430

(1.5)

7460

(2.3)

PD + HD 1/week

1541

(0.5)

35

(0.1)

1576

(0.5)

PD + HD 2/week

177

(0.1)

8

(0.0)

185

(0.1)

PD + HD 3/week

27

(0.0)

3

(0.0)

30

(0.0)

PD + HD other frequencies

68

(0.0)

3

(0.0)

71

(0.0)

 

Total prevalent dialysis patients

295,359

(100.0)

29,627

(100.0)

324,986

(100.0)

Per million of general population

2592.4 patients (increase of 75.1 patients)

Prevalent patients receiving dialysis at 5 p.m. or later

33,370 patients

Incident hemodialysis patients (including HDF)

37,265 patients

Incident peritoneal dialysis patients

2197 patients

Incident dialysis patients

39,462 patients (increase of 1135 patients, 3.0% increase)

Deceased patients

31,068 patients

(Increase of 361 patients, 1.2% increase)

   

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

The above data were obtained from the patient survey

Table 2

Changes in the number of bedside consoles, 1980–2015

 

1980/12

1981/12

1982/12

1983/12

1984/12

1985/12

1986/12

1987/12

1988/12

1989/12

1990/12

1991/12

1992/12

1993/12

1994/12

1995/12

1996/12

1997/12

Number of facilities

1278

1314

1425

1442

1514

1587

1745

1845

1962

1726

2101

2385

2520

2629

2752

2866

2961

3026

Number of bedside consoles

18,963

21,032

22,939

24,474

26,558

28,715

30,846

33,527

36,447

34,099

40,723

45,682

49,650

53,262

58,561

59,715

63,742

66,880

 

1998/12

1999/12

2000/12

2001/12

2002/12

2003/12

2004/12

2005/12

2006/12

2007/12

2008/12

2009/12

2010/12

2011/12

2012/12

2013/12

2014/12

2015/12

Number of facilities

3085

3220

3358

3485

3612

3717

3882

3940

3985

4052

4081

4133

4166

4213

4238

4268

4330

4321

Number of bedside consoles

69,733

75,448

79,709

83,914

89,070

92,710

97,366

100,552

104,382

108,583

111,998

114,979

118,622

121,863

125,003

128,150

131,555

133,538

The low response rate in 1989 caused a dip in facility or dialysis machine numbers

The above data were obtained from the patient survey

Number of dialysis patients

Based on the facility survey, the total number of patients receiving chronic dialysis therapy at the end of 2015 was 324,986, which represents the prevalence of chronic kidney disease patients undergoing dialysis therapy. The number of dialysis patients increased by approximately 10,000 people annually through 2005, but this rate has been slowing in recent years. At the end of 2014, the number had increased by 6010 from the previous year, and at the end of 2015, it had increased by 4538 people (Fig. 1, Table 3). (In the figure, the decrease in the number of patients at the end of 1989 is apparently the effect of the exceptionally low 86% questionnaire response rate that year [2]).
Figure 1
Fig. 1

Changes in the number of prevalent dialysis patients, 1968–2015. The low response rate in 1989 caused a dip in patient numbers

Table 3

Prevalent, incident, and deceased dialysis patient counts and adjusted rates, 1983–2015

 

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Prevalent dialysis patients

53,017

59,811

66,310

73,537

80,553

88,534

83,221

103,296

116,303

123,926

134,298

143,709

154,413

167,192

175,988

185,322

197,213

Incident dialysis patients

11,348

12,606

13,416

14,175

14,699

16,470

14,174

18,411

20,877

22,475

23,874

24,296

26,398

28,409

28,870

29,641

31,483

Deceased dialysis patients

4538

5000

5770

6296

6581

7765

6766

8939

9722

11,621

12,143

13,187

14,406

15,174

16,102

16,687

18,524

Adjusted prevalent dialysis patients (pmp)

443.7

497.5

547.8

604.4

658.8

721.1

790.0

835.7

937.6

995.8

1076.4

1149.4

1229.7

1328.4

1394.9

1465.2

1556.7

 

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

 

Prevalent dialysis patients

206,134

219,183

229,538

237,710

248,166

257,765

264,473

275,242

283,421

290,661

298,252

304,856

310,007

314,438

320,448

324,986

 

Incident dialysis patients

32,018

33,243

33,710

33,966

35,084

36,063

36,373

36,934

38,180

37,566

37,512

38,613

38,055

38,095

38,327

39,462

 

Deceased dialysis patients

18,938

19,850

20,614

21,672

22,715

23,983

24,034

25,253

27,266

27,646

28,882

30,743

30,710

30,751

30,707

31,068

 

Adjusted prevalent dialysis patients (pmp)

1624.1

1721.9

1801.2

1862.7

1943.5

2017.6

2069.9

2154.2

2219.6

2279.5

2329.1

2385.4

2431.1

2470.1

2521.6

2557.0

 

The above data were obtained from the patient survey

The numbers of dialysis patients were adjusted as per million population (pmp) by the annual government report [7]

In 2012, Nakai et al. [3] predicted the number of future dialysis patients, stating that the number would decrease from a peak of approximately 348,000 in 2021. The number of dialysis patients per million of the population (pmp) would be 2592.4 persons, an increase of 75.1 people from the previous year, meaning there would be one dialysis patient for every 385.7 Japanese citizens (Table 3) [7]. The population of Japan has been on the decline since 2011; thus, the percentage of the population has increased year by year. Incidentally, the highest number of dialysis patients pmp in the world is in Taiwan, with Japan following a close second [8]. In contrast, the number of incident dialysis patients represents the incidence of chronic kidney disease patients undergoing dialysis therapy, and although the number of incident dialysis patients before 2008 showed an increasing trend, it began to exhibit a decrease in 2009. Since then, faint fluctuations in the number of patients have been observed, but the rate has remained largely constant. However, the number of incident dialysis patients in 2015 increased 1135 persons from the previous year to 39,462, exceeding 39,000 persons for the first time (Fig. 2, Table 3). In contrast, the annual number of deceased patients has consistently increased through 2011. However, since then the rate has remained mostly constant. The number of deceased 2015 prevalent patients increased to 31,068, an increase of 361 persons from 2014, exceeding 31,000 persons for the first time (Fig. 2, Table 3).
Figure 2
Fig. 2

Incident and deceased dialysis patient counts, 1983–2015

Distribution of dialysis patients by treatment modality and prefecture

Tabulation in the 2015 JRDR survey was switched to a method focusing upon treatment modality, such as HDF, which showed a rapid increase in use recently. The percentages held by each therapeutic method are 79.5% for HD, 17.0% for HDF, 0.0% for hemofiltration (HF), 0.4% for hemoadsorption dialysis, 2.9% for PD, and 0.2% for home hemodialysis (HHD) (Table 1). The percentage of total home dialysis therapy in Japan including PD and HHD was 3.1%, which was the lowest in the developed world [8]. HDF therapy, particularly online HDF, had dramatically increased in use since the 2012 revision of the medical payment system, and the total number of patients using HDF at the end of 2015 was 55,333 persons. A total of 9322 patients were treated by PD, which represented a slight increase from 9255 in 2014. Twenty percent of all PD patients were on the combination therapy with HDF, a percentage which has remained largely constant for the past 5 years. A total of 572 patients were on HHD, which was a 43-person increase from 2014. This represented a large rate of increase, but the percentage of all therapies was still small. Thirty-three thousand three hundred seventy patients were treated in nighttime dialysis at the end of 2015, which represented a decrease from 41,271 persons in 2014. The number of nighttime dialysis patients was approximately 41,000 to 42,000 persons for several years. However, it is possible that either it actually decreased in 2015 or changes in how the number of nighttime dialysis patients are entered in the 2015 survey, and furthermore, the addition of “Dialysis for a given period of time recognized by insurance as starting after 5:00 p.m. or ending after 9:00 p.m.” as the definition of nighttime dialysis in annotated response fields had an influence; thus, future trends require attentive observation. The total number of incident dialysis patients was 39,462 persons, of whom 94.4% began HDF or similar therapies, and 5.6% began PD. Changes in how incident HDF as well as incident PD cases were entered may have influenced the tabulated values.

Before 2014, the number of chronic dialysis patients by prefecture was presented categorized into daytime dialysis, nighttime dialysis, HHD, and PD, but the tabulation method was changed to details on the treatment modality from the 2015 JRDR survey. The number of dialysis patients in prefectures is governed by fundamental population differences, and those differences remain large on the order of the patient number in pmp. The mean in Japan is 2592.4 pmp, but greatly differs depending on the region from 1963.7 pmp (Akita Prefecture) to 3712.8 pmp (Tokushima Prefecture). Similarly, regional differences in the percentages of each treatment modality were found, and the percentage of HDF representing all dialysis patients has a nationwide mean of 17.0%, although major differences ranging from 6.6% (Miyazaki Prefecture) to 41.5% (Shimane Prefecture) were found. The percentage of PD patients also similarly has a nationwide mean of 2.9%, but major differences ranging from 0.7% (Saga Prefecture) to 7.3% (Kagawa Prefecture) (Table 4) were found.
Table 4

Prevalent dialysis patient counts, by modality and prefecture, 2015

Prefecture

Hemodialysis

Peritoneal dialysis

Total

Per million of general population

 

Hemodialysis

Hemodiafiltration

Hemofiltration

Blood adsorption filtration

Home hemodialysis

PD only

PD + HD 1/week

PD + HD 2/week

PD + HD 3/week

PD + HD other frequencies

  

Hokkaido

11,600

3264

2

78

9

297

79

7

1

1

15,338

2860.0

Aomori

2565

851

0

3

1

62

13

2

0

0

3497

2679.7

Iwate

2720

206

0

17

0

93

9

0

0

0

3045

2388.2

Miyagi

4534

741

0

18

0

96

4

2

0

0

5395

2324.4

Akita

1504

432

0

3

2

57

3

2

0

0

2003

1963.7

Yamagata

1921

592

0

4

11

54

10

4

0

0

2596

2322.0

Fukushima

3648

1054

0

11

1

115

44

11

1

0

4885

2564.3

Ibaraki

6776

1066

1

31

9

76

27

0

0

0

7986

2774.8

Tochigi

5121

837

1

15

1

79

14

1

0

1

6070

3119.2

Gunma

4733

1133

1

6

9

56

10

0

0

0

5948

3073.9

Saitama

13,023

3913

1

68

76

208

84

4

3

2

17,382

2429.0

Chiba

11,230

2879

1

34

8

192

61

5

1

1

14,412

2350.3

Tokyo

23,397

6105

3

152

72

807

242

15

2

10

30,805

2345.3

Kanagawa

16,163

3566

0

72

33

551

66

1

1

1

20,454

2275.4

Niigata

4427

422

0

19

0

126

24

1

2

1

5022

2189.2

Toyama

2092

286

0

18

2

90

15

3

0

0

2506

2373.1

Ishikawa

2234

313

0

23

3

65

8

1

0

0

2647

2313.8

Fukui

1369

330

0

11

3

82

23

4

0

2

1824

2347.5

Yamanashi

1764

424

0

7

1

37

15

0

0

0

2248

2728.2

Nagano

3833

1281

0

4

10

95

23

4

0

1

5251

2531.8

Gifu

4007

684

0

29

26

88

15

4

0

0

4853

2428.9

Shizuoka

8086

2324

1

37

16

119

25

5

2

0

10,615

2911.4

Aichi

15,115

1898

1

100

46

582

81

2

0

1

17,826

2435.2

Mie

3749

318

0

22

5

67

14

1

0

0

4176

2342.1

Shiga

2483

449

0

16

30

117

26

0

0

1

3122

2239.6

Kyoto

5294

788

3

66

12

161

66

4

3

3

6400

2490.3

Osaka

19,483

2969

0

123

30

481

97

12

4

0

23,199

2672.7

Hyogo

10,459

2545

0

75

66

168

44

14

1

2

13,374

2448.1

Nara

2480

720

0

39

5

115

37

2

2

1

3401

2508.1

Wakayama

2631

278

0

28

19

38

7

1

0

1

3003

3131.4

Tottori

1086

351

0

3

1

45

11

3

1

0

1501

2633.3

Shimane

881

665

0

0

1

47

6

4

0

0

1604

2328.0

Okayama

3731

969

0

28

5

171

15

1

0

0

4920

2584.0

Hiroshima

5424

1752

1

33

28

242

64

52

0

3

7599

2704.3

Yamaguchi

2453

931

0

7

0

91

34

1

1

0

3518

2523.7

Tokushima

1999

623

0

2

4

125

31

0

0

8

2792

3712.8

Kagawa

1917

563

0

13

8

147

47

2

0

0

2697

2783.3

Ehime

2504

1219

0

10

0

106

27

0

0

14

3880

2817.7

Kochi

1539

750

0

6

0

13

3

0

0

0

2311

3187.6

Fukuoka

12,461

1428

0

55

7

677

29

1

0

3

14,661

2900.3

Saga

2088

263

0

6

1

12

3

1

0

0

2374

2863.7

Nagasaki

3483

370

0

9

5

119

16

2

2

0

4006

2924.1

Kumamoto

5740

517

0

25

1

133

22

0

0

4

6442

3623.2

Oita

3379

368

0

6

2

121

38

4

0

0

3918

3383.4

Miyazaki

3290

235

0

5

0

39

1

0

0

2

3572

3247.3

Kagoshima

4683

647

1

20

1

111

29

2

1

4

5499

3349.0

Okinawa

3275

1014

0

11

2

87

14

0

2

4

4409

3098.4

Total

258,374

55,333

17

1368

572

7460

1576

185

30

71

324,986

2557.0

%

(79.5)

(17.0)

(0.0)

(0.4)

(0.2)

(2.3)

(0.5)

(0.1)

(0.0)

(0.0)

(100.0)

 

The above data were obtained from the patient survey

The numbers of dialysis patients were adjusted as per million population (pmp) by the annual government report [7]

Mean age, sex, and dialysis vintage

The ages and sexes of chronic dialysis patients continues to change over time; hence, patients need to be divided into 2015 incident dialysis patients and prevalent dialysis patients, through which trends were identified over time. The number of patients who were entered into the patient survey table and initiated dialysis in 2015 with confirmed age and sex was 36,792. This is equal to 93.2%, or 2670 persons less than the 39,462 persons recorded into the facility survey. There were 25,004 males and 11,788 females, and similarly to the previous year, there were approximately twice as many males as females. The mean age of all incident dialysis patients was 69.20 years, representing a 0.16-year increase compared with the 69.04 year mean age at the end of 2014. The mean age was 68.37 years for men and 70.95 years for women, which compared with the previous year represented a 0.23-year and 0.04-year increase, respectively. If incident patients are categorized into 5-year age groups (Fig. 3, Table 5), then the age groups with the highest percentages were men aged between 65 and 69 years and women aged between 80 and 84 years. Very elderly patients 75 years or older accounted for 45.8% of females and 36.6% of males. In contrast, the total number of 2015 prevalent patients with sex and age recorded into patient questionnaires was 313,212 persons, equal to 96.4% or 11,774 persons less than the 324,986 persons in facility questionnaires. The mean age of prevalent patients was 67.86 years, or a 0.32-year increase from the previous year. The mean age of males was 67.07 years, which meant a 0.32-year increase, and the mean age of females was 69.28 years, representing a 0.34-year increase (Fig. 4, Table 6). The age group with the highest percentage was males and females aged 65 to 69 years. As shown in the annual changes in the mean age of incident and prevalent patients, both groups exhibited an increase linearly. However, in recent years, this increase has been slowing (Fig. 5, Table 7).
Figure 3
Fig. 3

Incident dialysis patient distribution, by age and sex, 2015

Table 5

Incident dialysis patient distribution, by age and sex, 2015

Age at dialysis initiation

Male

Female

Subtotal

No information available

Total

< 5

6

4

10

 

10

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

5 ≤, < 10

3

2

5

 

5

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

10 ≤, < 15

4

3

7

 

7

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

15 ≤, < 20

12

13

25

 

25

(%)

(0.0)

(0.1)

(0.1)

 

(0.1)

20 ≤, < 25

36

15

51

 

51

(%)

(0.1)

(0.1)

(0.1)

 

(0.1)

25 ≤, < 30

94

42

136

 

136

(%)

(0.4)

(0.4)

(0.4)

 

(0.4)

30 ≤, < 35

199

70

269

 

269

(%)

(0.8)

(0.6)

(0.7)

 

(0.7)

35 ≤, < 40

360

159

519

 

519

(%)

(1.4)

(1.3)

(1.4)

 

(1.4)

40 ≤, < 45

752

273

1025

 

1025

(%)

(3.0)

(2.3)

(2.8)

 

(2.8)

45 ≤, < 50

1025

404

1429

 

1429

(%)

(4.1)

(3.4)

(3.9)

 

(3.9)

50 ≤, < 55

1486

494

1980

 

1980

(%)

(5.9)

(4.2)

(5.4)

 

(5.4)

55 ≤, < 60

1735

621

2356

 

2356

(%)

(6.9)

(5.3)

(6.4)

 

(6.4)

60 ≤, < 65

2571

1020

3591

 

3591

(%)

(10.3)

(8.7)

(9.8)

 

(9.8)

65 ≤, < 70

3846

1610

5456

 

5456

(%)

(15.4)

(13.7)

(14.8)

 

(14.8)

70 ≤, < 75

3718

1663

5381

 

5381

(%)

(14.9)

(14.1)

(14.6)

 

(14.6)

75 ≤, < 80

3750

1808

5558

 

5558

(%)

(15.0)

(15.3)

(15.1)

 

(15.1)

80 ≤, < 85

3266

1923

5189

 

5189

(%)

(13.1)

(16.3)

(14.1)

 

(14.1)

85 ≤, < 90

1714

1243

2957

 

2957

(%)

(6.9)

(10.5)

(8.0)

 

(8.0)

90 ≤, < 95

381

381

762

 

762

(%)

(1.5)

(3.2)

(2.1)

 

(2.1)

95 ≤

46

40

86

 

86

(%)

(0.2)

(0.3)

(0.2)

 

(0.2)

Subtotal

25,004

11,788

36,792

 

36,792

(%)

(100.0)

(100.0)

(100.0)

 

(100.0)

Unknown

3

2

5

 

5

No information available

     

Total

25,007

11,790

36,797

 

36,797

Mean age

68.37

70.95

69.20

 

69.20

S.D.

13.26

13.48

13.39

 

13.39

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

The above data were obtained from the patient survey

Figure 4
Fig. 4

Prevalent dialysis patient distribution, by age and sex, 2015

Table 6

Prevalent dialysis patient distribution, by age and sex, 2015

Age at the end of 2015

Male

Female

Subtotal

No information available

Total

< 5

14

23

37

 

37

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

5 ≤, < 10

15

13

28

 

28

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

10 ≤, < 15

24

14

38

 

38

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

15 ≤, < 20

61

43

104

 

104

(%)

(0.0)

(0.0)

(0.0)

 

(0.0)

20 ≤, < 25

125

87

212

 

212

(%)

(0.1)

(0.1)

(0.1)

 

(0.1)

25 ≤, < 30

454

200

654

 

654

(%)

(0.2)

(0.2)

(0.2)

 

(0.2)

30 ≤, < 35

1110

551

1661

 

1661

(%)

(0.6)

(0.5)

(0.5)

 

(0.5)

35 ≤, < 40

2631

1167

3798

 

3798

(%)

(1.3)

(1.0)

(1.2)

 

(1.2)

40 ≤, < 45

5844

2553

8397

 

8397

(%)

(2.9)

(2.3)

(2.7)

 

(2.7)

45 ≤, < 50

9386

3891

13,277

 

13,277

(%)

(4.7)

(3.5)

(4.2)

 

(4.2)

50 ≤, < 55

12,900

5654

18,554

 

18,554

(%)

(6.4)

(5.1)

(5.9)

 

(5.9)

55 ≤, < 60

16,695

7815

24,510

 

24,510

(%)

(8.3)

(7.0)

(7.8)

 

(7.8)

60 ≤, < 65

25,166

12,759

37,925

 

37,925

(%)

(12.5)

(11.4)

(12.1)

 

(12.1)

65 ≤, < 70

36,926

19,055

55,981

 

55,981

(%)

(18.3)

(17.0)

(17.9)

 

(17.9)

70 ≤, < 75

30,637

17,091

47,728

 

47,728

(%)

(15.2)

(15.3)

(15.2)

 

(15.2)

75 ≤, < 80

27,064

15,968

43,032

 

43,032

(%)

(13.4)

(14.3)

(13.7)

 

(13.7)

80 ≤, < 85

20,321

13,582

33,903

 

33,903

(%)

(10.1)

(12.1)

(10.8)

 

(10.8)

85 ≤, < 90

9496

8317

17,813

 

17,813

(%)

(4.7)

(7.4)

(5.7)

 

(5.7)

90 ≤, < 95

2193

2695

4888

 

4888

(%)

(1.1)

(2.4)

(1.6)

 

(1.6)

95 ≤

272

400

672

 

672

(%)

(0.1)

(0.4)

(0.2)

 

(0.2)

Subtotal

201,334

111,878

313,212

 

313,212

(%)

(100.0)

(100.0)

(100.0)

 

(100.0)

Unspecified

2

2

4

 

4

No information available

1

 

1

 

1

Total

201,337

111,880

313,217

 

313,217

Mean

67.07

69.28

67.86

 

67.86

S.D.

12.37

12.58

12.49

 

12.49

The above data were obtained from the patient survey

Figure 5
Fig. 5

Average age of incident and prevalent dialysis patients, 1983–2015

Table 7

Mean age of incident and prevalent dialysis patients, 1983–2015

 

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Mean age of the incident dialysis patients

51.9

53.2

54.4

55.1

55.9

56.9

57.4

58.1

58.1

59.5

59.8

60.4

61.0

61.5

62.2

62.7

63.4

Mean age of the prevalent dialysis patients

48.3

49.2

50.3

51.1

52.1

52.9

53.8

54.5

55.3

56.0

56.6

57.3

58.0

58.6

59.2

59.9

60.6

 

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

 

Mean age of the incident dialysis patients

63.8

64.2

64.7

65.4

65.8

66.2

66.4

66.8

67.2

67.3

67.8

67.8

68.4

68.7

69.0

69.2

 

Mean age of the prevalent dialysis patients

61.2

61.6

62.2

62.8

63.3

63.9

64.4

64.9

65.3

65.8

66.2

66.6

66.9

67.2

67.5

67.9

 

The above data were obtained from the patient survey

As indicated in the changes over time in the number of prevalent patients in each survey year by age, the number of patients less than 65 years showed signs of increasing by the end of 2011, but this became a decreasing trend from the end of 2012 against the background of increasing age among incident patients. The number of patients younger than 65 years at the end of 2015 was 109,195, a decrease of 3264 persons compared with the end of 2014. In other words, the increase in the number of chronic dialysis patients in Japan was due to the increase in the number of patients aged 65 years or older. Furthermore, an increase was observed in the percentage of the very elderly aged 75 years or older, resulting in 5560 dialysis patients aged 90 years or older (Fig. 6, Table 8).
Figure 6
Fig. 6

Prevalent dialysis patient distribution, by age, 1982–2015

Table 8

Prevalent dialysis patient distribution, by age, 1982–2015

Age

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

< 20

849

683

628

527

517

587

505

438

470

606

580

576

596

579

555

546

516

20 ≤, < 30

3050

3060

2972

2900

2758

2927

2703

2512

2656

2985

2947

3001

3153

3125

3240

3177

3028

30 ≤, < 40

9378

10,191

10,790

11,490

11,695

12,285

11,089

9782

9611

9913

9426

9340

9123

8984

8842

8934

8857

40 ≤, < 50

10,668

12,030

13,399

14,609

15,493

18,495

19,671

20,011

22,088

25,169

25,751

26,510

27,355

28,420

29,267

28,019

26,087

50 ≤, < 60

9835

11,783

13,512

15,648

17,418

21,196

22,221

22,254

25,259

30,444

32,392

35,043

37,711

39,047

41,068

43,463

46,401

60 ≤, < 65

3346

4101

5086

6094

6931

8943

9922

10,496

12,296

15,045

16,596

18,069

20,056

21,817

23,550

25,052

25,838

65 ≤, < 70

2633

3107

3628

4469

5066

6382

7177

7837

9388

12,060

13,566

15,612

17,600

19,572

21,635

23,484

25,160

70 ≤, < 75

1657

2232

2788

3437

3975

4899

5339

5497

6669

8370

9371

10,756

12,450

14,016

16,277

18,597

20,607

75 ≤, < 80

668

955

1258

1662

2021

2896

3377

3853

4608

5891

6550

7350

8126

9200

10,471

11,738

13,282

80 ≤, < 90

180

256

369

541

725

1179

1430

1730

2384

3252

3872

4787

6003

7052

8366

9344

10,650

90 ≤

2

4

10

12

14

43

52

62

68

92

124

181

219

313

354

473

599

Age

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

< 20

473

417

388

389

308

274

253

227

232

215

215

179

183

215

210

226

207

20≤, < 30

2846

2809

2572

2427

2246

2039

1842

1653

1571

1454

1346

1260

1221

1119

1027

928

866

30≤, < 40

8541

8953

8910

8896

8860

8681

8228

8371

8235

7960

7687

7312

7009

6674

6251

5789

5459

40≤, < 50

23,958

23,371

22,601

21,895

21,227

20,454

19,798

19,530

20,203

20,385

20,690

20,999

21,360

21,534

21,837

21,901

21,674

50≤, < 60

48,113

51,868

53,261

54,600

55,504

55,390

55,779

56,711

55,424

52,730

49,874

47,261

45,802

44,593

43,933

43,263

43,064

60≤, < 65

25,965

28,155

29,890

31,358

33,417

34,975

33,666

33,492

36,939

39,849

42,982

46,894

48,955

47,162

44,032

40,352

37,925

65≤, < 70

26,208

29,022

30,473

32,733

33,747

34,759

35,290

37,469

39,521

41,922

43,932

43,160

42,203

45,664

49,118

52,259

55,981

70≤, < 75

22,066

25,001

26,212

28,638

30,564

32,198

33,966

35,862

38,861

40,096

41,173

42,638

44,581

45,430

47,622

49,367

47,728

75≤, < 80

14,657

16,953

18,466

20,961

23,248

25,272

26,767

28,552

31,638

33,565

35,605

37,951

39,700

41,255

41,937

42,251

43,032

80≤, < 90

11,679

13,978

15,034

16,785

18,714

20,639

22,765

25,663

29,090

32,133

35,174

38,028

40,681

43,578

46,210

48,746

51,716

90≤

724

933

984

1284

1550

1824

2100

2363

2636

2924

3301

3762

4036

4314

4736

5005

5560

The above data were obtained from the patient survey

The dialysis vintages of 2015 prevalent patients were evaluated in a 5-year-segment (Fig. 7, Table 9), then patients with a dialysis vintage of less than 5 years accounted for 47.3% of the total. Twenty-five thousand three hundred ninety-one patients had a dialysis vintage of 20 years or longer, which represents an increase of 561 persons or 8.1% of the total compared with the previous year. Six hundred seventeen persons had a dialysis vintage of longer than 40 years, it was 0.2% of all dialysis patients. The longest dialysis vintage was 47 years and 6 months. Regardless of dialysis vintage, the absolute number of males tended to be higher than females, a difference that became smaller the longer the dialysis vintage is. At less than 5 years, the male percentage was 67.5%, but it decreased to 51.4% in patients with dialysis vintages of 30 to 34 years. However, the percentage of male patients with dialysis vintages of 35 to 39 years and 40 years or longer increased again to 53.2 and 55.3%, respectively. Chronic dialysis therapy was first covered by insurance in Japan in 1967, and it is believed this had an effect. The percentage of patients with vintages less than 5 years has gradually decreased, whereas patients with long vintages have been increasing. Patients with dialysis vintages of 10 years or longer have now reached 27.8%. Patients with vintages of 20 years or longer did not reach 1.0% in 1992, but reached 8.1% by the end of 2015 (Fig. 8, Table 10).
Figure 7
Fig. 7

Prevalent dialysis patient distribution, by sex and dialysis vintage, 2015

Table 9

Prevalent dialysis patient distribution, by sex and dialysis vintage, 2015

Dialysis vintage (years)

Male

Female

Subtotal

No information available

Total

< 5

99,944

48,073

148,017

 

148,017

(%)

(49.7)

(43.0)

(47.3)

 

(47.3)

5  ≤, < 10

50,569

27,232

77,801

 

77,801

(%)

(25.1)

(24.4)

(24.9)

 

(24.9)

10 ≤, < 15

24,517

15,543

40,060

 

40,060

(%)

(12.2)

(13.9)

(12.8)

 

(12.8)

15 ≤, < 20

12,426

9129

21,555

 

21,555

(%)

(6.2)

(8.2)

(6.9)

 

(6.9)

20 ≤, < 25

6591

5440

12,031

 

12,031

(%)

(3.3)

(4.9)

(3.8)

 

(3.8)

25 ≤, < 30

3560

3170

6730

 

6730

(%)

(1.8)

(2.8)

(2.2)

 

(2.2)

30 ≤, < 35

2014

1903

3917

 

3917

(%)

(1.0)

(1.7)

(1.3)

 

(1.3)

35 ≤, < 40

1116

980

2096

 

2096

(%)

(0.6)

(0.9)

(0.7)

 

(0.7)

40 ≤

341

276

617

 

617

(%)

(0.2)

(0.2)

(0.2)

 

(0.2)

Subtotal

201,078

111,746

312,824

 

312,824

(%)

(100.0)

(100.0)

(100.0)

 

(100.0)

Unspecified

258

134

392

 

392

No information available

1

 

1

 

1

Total

201,337

111,880

313,217

 

313,217

Mean

6.81

8.22

7.31

 

7.31

S.D.

7.16

8.14

7.55

 

7.55

The above data were obtained from the patient survey

Figure 8
Fig. 8

Prevalent dialysis patient distribution, by dialysis vintage, 1988–2015

Table 10

Prevalent dialysis patient distribution, by dialysis vintage, 1988–2015

Dialysis vintage (years)

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

 < 5

47,087

46,617

52,327

63,584

65,835

71,547

77,690

82,757

89,049

93,402

97,230

99,120

106,993

107,803

 5 ≤, < 10

22,423

22,238

24,472

27,709

29,775

31,340

33,162

35,145

37,524

39,781

42,163

43,365

47,792

50,888

 10 ≤, < 15

11,783

12,285

13,704

15,418

16,438

17,102

18,228

18,934

19,820

20,604

21,052

21,150

22,826

24,050

 15 ≤, < 20

2441

3485

5089

6974

8429

9479

10,436

11,142

11,755

12,193

12,600

12,594

13,199

13,765

 20 ≤, < 25

28

95

242

566

1170

2001

3035

4202

5364

6308

6952

7342

8024

8450

 25 ≤

0

0

0

2

8

23

75

193

448

874

1485

2114

3076

4080

Dialysis vintage (years)

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

 < 5

113,075

117,116

120,159

121,803

124,576

130,708

133,827

136,934

139,371

141,076

143,360

145,064

146,085

148,017

 5 ≤, < 10

53,766

56,169

58,357

59,295

62,117

66,076

68,617

71,251

73,320

75,073

75,991

77,197

77,862

77,801

 10 ≤, < 15

25,376

26,710

27,738

28,550

30,318

32,270

33,696

35,074

36,338

37,588

38,547

39,490

40,032

40,060

 15 ≤, < 20

14,206

14,463

14,453

14,605

15,419

16,472

17,265

18,111

18,852

19,534

20,238

20,874

21,213

21,555

 20 ≤, < 25

8765

8992

9034

8838

9252

9603

9815

9876

10,335

10,629

11,015

11,421

11,802

12,031

 25 ≤

5008

5996

6865

7422

8275

9227

10,017

10,750

11,233

11,835

12,307

12,766

13,028

13,360

The above data were obtained from the patient survey

Primary diseases

The primary diseases of chronic dialysis patients have continued to change over time; hence, incident dialysis patients and 2015 prevalent patients need to be divided for the study. We shall discuss this point while comparing the two groups.

The most frequent primary disease among the 2015 incident dialysis patients was diabetic nephropathy, chronic glomerulonephritis, and nephrosclerosis at 43.7, 16.9, and 14.2%, respectively; however, 12.2% had an unknown primary disease. The mean age at incidence was 67.29, 68.77, and 75.33 years for diabetic nephropathy, chronic glomerulonephritis, and nephrosclerosis, respectively (Table 11). The most frequent primary disease for 2015 prevalent patients was diabetic nephropathy, chronic glomerulonephritis, and nephrosclerosis at 38.4, 29.8, and 9.5%, respectively; however, 9.5% had an unknown primary disease (Table 12). The mean age was 66.90, 67.52, and 74.25 years for chronic glomerulonephritis, diabetic nephropathy, and nephrosclerosis, respectively. Both incident and prevalent dialysis patients showed a high mean age for nephrosclerosis and a low mean age for kidney diseases due to congenital abnormalities.
Table 11

Incident dialysis patient distribution, by primary disease, 2015

Primary disease

Total

Mean age

S.D.

Chronic glomerulonephritis (%)

6232 (16.9)

68.77

14.37

Chronic pyelonephritis (%)

256 (0.7)

67.56

15.69

RPGN (%)

463 (1.3)

73.12

12.13

PIH (%)

30 (0.1)

62.60

13.63

Unclassified nephritis (%)

141 (0.4)

67.42

16.08

PKD (%)

939 (2.6)

62.50

13.69

Nephrosclerosis (%)

5225 (14.2)

75.33

11.31

Hypertensive emergencies (%)

296 (0.8)

63.61

17.74

Diabetes (%)

16,072 (43.7)

67.29

12.21

Lupus nephritis (%)

269 (0.7)

63.76

14.35

Amyloidosis (%)

112 (0.3)

69.72

10.61

Gout (%)

83 (0.2)

62.70

14.38

Inborn errors of metabolism (%)

19 (0.1)

48.37

23.20

Tuberculosis (%)

9 (0.0)

81.00

8.49

Urolithiasis (%)

76 (0.2)

71.75

12.14

Neoplasm of kidney and urinary tract (%)

177 (0.5)

72.74

10.38

Urinary tract obstruction (%)

104 (0.3)

68.98

13.56

Myeloma (%)

142 (0.4)

71.73

9.87

Hypoplastic kidney (%)

51 (0.1)

45.47

26.79

Undetermined (%)

4473 (12.2)

72.04

13.38

Rejected kidney (%)

216 (0.6)

55.67

15.07

Others (%)

1411 (3.8)

69.68

14.96

Subtotal (%)

36,796 (100.0)

69.20

13.39

No information available

1

74.00

 

Total

36,797

69.20

13.39

The above data were obtained from the patient survey

Table 12

Prevalent dialysis patient distribution, by primary disease, 2015

Primary disease

Total

Mean age

S.D.

Chronic glomerulonephritis (%)

93,347 (29.8)

66.90

12.46

Chronic pyelonephritis (%)

2935 (0.9)

65.62

13.84

RPGN (%)

2478 (0.8)

69.23

12.93

PIH (%)

1545 (0.5)

65.06

10.23

Unclassified nephritis (%)

1405 (0.4)

61.33

16.85

PKD (%)

11,256 (3.6)

65.16

11.37

Nephrosclerosis (%)

29,805 (9.5)

74.25

11.74

Hypertensive emergencies (%)

2618 (0.8)

64.04

14.88

Diabetes (%)

120,278 (38.4)

67.52

11.33

Lupus nephritis (%)

2227 (0.7)

61.64

13.68

Amyloidosis (%)

462 (0.1)

68.19

11.35

Gout (%)

1075 (0.3)

67.76

11.37

Inborn errors of metabolism (%)

274 (0.1)

49.53

17.23

Tuberculosis (%)

195 (0.1)

73.25

8.86

Urolithiasis (%)

581 (0.2)

70.89

11.13

Neoplasm of kidney and urinary tract (%)

910 (0.3)

72.35

10.55

Urinary tract obstruction (%)

730 (0.2)

64.08

16.36

Myeloma (%)

291 (0.1)

70.76

10.83

Hypoplastic kidney (%)

660 (0.2)

45.40

19.35

Undetermined (%)

29,897 (9.5)

69.98

13.12

Rejected kidney (%)

2183 (0.7)

56.77

12.54

Others (%)

8044 (2.6)

66.17

15.45

Subtotal (%)

313,196 (100.0)

67.86

12.49

No information available

21

70.52

11.36

Total

313,217

67.86

12.49

The above data were obtained from the patient survey

The annual changes in primary diseases of incident dialysis patients showed that diabetic nephropathy was supplanted by chronic glomerulonephritis in 1998, which then became the most prevalent primary disease. Subsequently, the percentage of diabetic nephropathy exhibited an increasing trend, but then remained largely constant these past several years. The percentage of chronic glomerulonephritis has continued to decrease. In contrast, the percentage of nephrosclerosis and unknown primary disease has continued to increase (Fig. 9, Table 13).
Figure 9
Fig. 9

Incident dialysis patient distribution, by primary disease, 1983–2015. Abbreviations: PKD, polycystic kidney disease; RPGN, rapidly progressive glomerulonephritis

Table 13

Incident dialysis patient distribution, by primary disease, 1983–2015

Primary disease

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

 Diabetes

15.6

17.4

19.6

21.3

22.1

24.3

26.5

26.2

28.1

28.4

29.9

30.7

31.9

33.1

33.9

35.7

36.2

 Chronic glomerulonephritis

60.5

58.7

56.0

54.8

54.2

49.9

47.4

46.1

44.2

42.2

41.4

40.5

39.4

38.9

36.6

35.0

33.6

 Nephrosclerosis

3.0

3.3

3.5

3.7

3.9

3.9

4.1

5.4

5.5

5.9

6.2

6.1

6.3

6.4

6.8

6.7

7.0

 PKD

2.8

2.8

3.1

2.9

3.2

3.1

3.1

2.9

3.0

2.7

2.6

2.5

2.4

2.5

2.4

2.4

2.2

 Chronic pyelonephritis

2.4

2.2

2.1

2

1.8

1.8

1.5

1.5

1.7

1.6

1.1

1.4

1.2

1.1

1.2

1.1

1.1

 RPGN

0.9

0.7

0.9

1.0

0.8

0.9

0.8

0.7

0.6

0.7

0.8

0.8

0.8

0.8

1.1

0.9

0.9

 Lupus nephritis

1.1

1.1

1.1

1.2

0.9

0.9

1.0

1.1

1.3

1.3

1.2

1.2

1.1

1.3

1.0

1.1

1.2

 Undetermined

4.4

4.0

4.8

4.2

4.1

3.8

4.0

3.3

3.7

3.7

3.3

3.9

4.5

5.0

5.5

5.6

6.1

Primary disease

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

 

 Diabetes

36.6

38.1

39.1

41.0

41.3

42.0

42.9

43.4

43.3

44.5

43.6

44.3

44.2

43.8

43.5

43.7

 

 Chronic glomerulonephritis

32.5

32.4

31.9

29.1

28.1

27.4

25.6

23.8

22.8

21.9

21.0

20.2

19.4

18.8

17.8

16.9

 

 Nephrosclerosis

7.6

7.6

7.8

8.5

8.8

9.0

9.4

10.0

10.6

10.7

11.7

11.8

12.3

13.1

14.2

14.2

 

 PKD

2.4

2.3

2.4

2.3

2.7

2.3

2.4

2.3

2.5

2.3

2.4

2.5

2.5

2.5

2.7

2.6

 

 Chronic pyelonephritis

1.0

1.1

0.9

1.0

0.9

1.0

0.8

0.8

0.7

0.7

0.8

0.7

0.8

0.8

0.7

0.7

 

 RPGN

1.0

1.0

1.1

1.2

1.1

1.1

1.2

1.3

1.2

1.2

1.2

1.3

1.3

1.4

1.4

1.3

 

 Lupus nephritis

0.9

1.0

0.9

0.7

0.8

0.8

0.8

0.8

0.8

0.7

0.8

0.7

0.7

0.7

0.7

0.7

 

 Undetermined

7.6

9.0

8.4

8.8

9.3

9.5

9.9

10.2

10.6

10.7

10.7

10.9

11.0

11.3

11.3

12.2

 

The above data were obtained from the patient survey

As the main primary disease among prevalent patients changed, diabetic nephropathy continuously increased and supplanted chronic glomerulonephritis in the 2011 survey as the most frequent primary disease. Thereafter, it has continuously increased, but the rate of increase seems to ebb slightly (Fig. 10, Table 14). Chronic glomerulonephritis is decreasing linearly, whereas nephrosclerosis and unknown primary diseases are continuously increasing. Otherwise, the numbers for polycystic kidney disease, chronic pyelonephritis, SLE nephritis, and rapidly progressive glomerulonephritis, for example, have remained constant as similar to previous years.
Figure 10
Fig. 10

Prevalent dialysis patient distribution, by primary disease, 1983–2015. Abbreviations: PKD, polycystic kidney disease; RPGN, rapidly progressive glomerulonephritis

Table 14

Prevalent dialysis patient distribution, by primary disease, 1983–2015

Primary disease

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

 Diabetes

7.4

8.4

9.4

10.5

11.7

12.8

14.0

14.9

16.4

17.1

18.2

19.2

20.4

21.6

22.7

24.0

25.1

 Chronic glomerulonephritis

74.5

72.1

72.3

70.6

69.4

67.9

65.9

64.1

61.7

60.4

58.8

57.7

56.6

55.4

54.1

52.5

51.1

 Nephrosclerosis

1.5

1.7

1.9

2.0

2.1

2.1

2.3

2.6

2.9

3.1

3.4

3.6

3.8

4.0

4.2

4.4

4.5

 PKD

2.7

2.9

3.0

3.1

3.1

3.2

3.2

3.3

3.3

3.3

3.3

3.2

3.2

3.2

3.2

3.2

3.2

 Chronic pyelonephritis

3.1

3.3

2.6

2.4

2.4

2.3

2.2

2.2

2.1

2.0

1.9

1.8

1.7

1.6

1.6

1.5

1.5

 RPGN

0.5

0.4

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.5

0.6

0.6

0.6

 Lupus nephritis

0.8

0.8

0.9

0.9

0.9

0.9

0.9

1.0

1.1

1.1

1.1

1.1

1.1

1.1

1.1

1.1

1.1

 Undetermined

2.2

2.3

2.3

2.5

2.6

2.5

2.6

2.6

2.9

2.9

2.9

3.1

3.2

3.6

3.9

4.2

4.4

Primary disease

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

 

 Diabetes

26.0

27.2

28.1

29.2

30.2

31.4

32.3

33.4

34.2

35.1

35.9

36.7

37.1

37.6

38.1

38.4

 

 Chronic glomerulonephritis

49.7

49.6

48.2

46.6

45.1

43.6

42.2

40.4

39.0

37.6

36.2

34.8

33.6

32.4

31.3

29.8

 

 Nephrosclerosis

4.8

5.0

5.1

5.3

5.7

5.9

6.2

6.5

6.8

7.1

7.5

7.9

8.3

8.7

9.1

9.5

 

 PKD

3.2

3.3

3.3

3.3

3.4

3.3

3.4

3.4

3.4

3.4

3.4

3.4

3.4

3.5

3.5

3.6

 

 Chronic pyelonephritis

1.4

1.4

1.3

1.3

1.3

1.2

1.2

1.2

1.1

1.1

1.1

1.0

1.0

1.0

1.0

0.9

 

 RPGN

0.6

0.6

0.6

0.6

0.6

0.6

0.6

0.7

0.7

0.7

0.7

0.7

0.8

0.8

0.8

0.8

 

 Lupus nephritis

1.0

1.0

1.0

0.9

0.9

0.9

0.9

0.9

0.8

0.8

0.8

0.8

0.8

0.7

0.7

0.7

 

 Undetermined

5.0

5.6

5.9

6.3

6.4

6.6

7.0

7.4

7.6

7.7

8.0

8.2

8.5

8.7

8.9

9.5

 

The above data were obtained from the patient survey

Causes of death

We compared the causes of death for all 2015 incident dialysis patients and 2015 prevalent dialysis patients overall. The highest causes of death in 2015 incident dialysis patients by sex were infectious disease (25.2%), heart failure (23.5%), malignant tumor (12.3%), and others (10.2%) in males and heart failure (27.3%), infectious disease (27.1%), others (11.8%), and malignant tumor (8.1%) in females. This ranking for males was the same as that at the end of 2014, but there was a 1.1-point decrease in infectious disease, a 0.4-point decrease in malignancy, and a 0.7-point increase in heart failure. This ranking for females has had heart failure as the most prevalent cause since 2010, and it increased by 1.8 points compared with that at the end of 2014. Overall, infectious disease was the most prevalent mortality factor at 25.8%, followed by heart failure (24.7%) as the second, and malignant tumor (10.9%) as the third (Fig. 11, Table 15). In the 2015 facility survey, 31,068 deaths were reported, but in the patient survey, the number of patients with cause of death and sex recorded was 29,064 persons, which was equal to 93.5% of the 31,068 deceased. Male mortality factors from the highest to the lowest were heart failure (24.8%), infectious disease (22.6%), malignancy (10.6%), and cerebrovascular disease (6.3%). Among females, the ranked list was heart failure (28.1%), infectious disease (20.9%), cerebrovascular disease (7.2%), and malignancy (7.0%). The ranked list among all deceased patients was heart failure (26.0%), infectious disease (22.0%), malignant tumor (9.3%), and cerebrovascular disease (6.6%).
Figure 11
Fig. 11

Incident dialysis patient distribution, by cause of death and sex, 2015

Table 15

Incident patient distribution, by cause of death and sex, 2015

Cause of death

Male

Female

Subtotal

No information available

Total

Heart failure (%)

342 (23.5)

192 (27.3)

534 (24.7)

 

534 (24.7)

Cerebrovascular disorder (%)

82 (5.6)

42 (6.0)

124 (5.7)

 

124 (5.7)

Infectious disease (%)

366 (25.2)

191 (27.1)

557 (25.8)

 

557 (25.8)

Hemorrhage (%)

27 (1.9)

10 (1.4)

37 (1.7)

 

37 (1.7)

Malignant tumors (%)

179 (12.3)

57 (8.1)

236 (10.9)

 

236 (10.9)

Cachexia/uremia (%)

72 (4.9)

34 (4.8)

106 (4.9)

 

106 (4.9)

Cardiac infarction (%)

45 (3.1)

16 (2.3)

61 (2.8)

 

61 (2.8)

Potassium poisoning/sudden death (%)

23 (1.6)

8 (1.1)

31 (1.4)

 

31 (1.4)

Chronic hepatitis/cirrhosis (%)

25 (1.7)

8 (1.1)

33 (1.5)

 

33 (1.5)

Suicide/refusal of treatment (dialysis) (%)

12 (0.8)

3 (0.4)

15 (0.7)

 

15 (0.7)

Intestinal obstruction (%)

17 (1.2)

7 (1.0)

24 (1.1)

 

24 (1.1)

Pulmonary thrombus/pulmonary embolus (%)

2 (0.1)

1 (0.1)

3 (0.1)

 

3 (0.1)

Death due to disaster (%)

5 (0.3)

3 (0.4)

8 (0.4)

 

8 (0.4)

Other causes (%)

148 (10.2)

83 (11.8)

231 (10.7)

 

231 (10.7)

Unspecified (%)

110 (7.6)

49 (7.0)

159 (7.4)

 

159 (7.4)

Subtotal (%)

1455 (100.0)

704 (100.0)

2159 (100.0)

 

2159 (100.0)

No information available

1

2

3

 

3

Total

1456

706

2162

 

2162

The above data were obtained from the patient survey

No change was observed in the order of any mortality factors by sex since 2014. The percentage of cardiovascular disease combining heart failure, cerebrovascular disease, and myocardial infarction was 35.7% among males, 39.0% among females, and 36.8% of the total (Fig. 12, Table 16).
Figure 12
Fig. 12

Deceased dialysis patient distribution, by cause of death and sex, 2015

Table 16

Deceased dialysis patient distribution, by cause of death and sex, 2015

Cause of death

Male

Female

Subtotal

No information available

Total

Heart failure (%)

4720 (24.8)

2824 (28.1)

7544 (26.0)

 

7544 (26.0)

Cerebrovascular disorder (%)

1188 (6.3)

728 (7.2)

1916 (6.6)

 

1916 (6.6)

Infectious disease (%)

4286 (22.6)

2107 (20.9)

6393 (22.0)

 

6393 (22.0)

Hemorrhage (%)

279 (1.5)

142 (1.4)

421 (1.4)

 

421 (1.4)

Malignant tumors (%)

2013 (10.6)

704 (7.0)

2717 (9.3)

 

2717 (9.3)

Cachexia/uremia (%)

740 (3.9)

599 (6.0)

1339 (4.6)

 

1339 (4.6)

Cardiac infarction (%)

867 (4.6)

378 (3.8)

1245 (4.3)

 

1245 (4.3)

Potassium poisoning/sudden death (%)

538 (2.8)

210 (2.1)

748 (2.6)

 

748 (2.6)

Chronic hepatitis/cirrhosis (%)

206 (1.1)

74 (0.7)

280 (1.0)

 

280 (1.0)

Suicide/refusal of treatment (dialysis) (%)

155 (0.8)

57 (0.6)

212 (0.7)

 

212 (0.7)

Intestinal obstruction (%)

194 (1.0)

113 (1.1)

307 (1.1)

 

307 (1.1)

Pulmonary thrombus/pulmonary embolus (%)

42 (0.2)

30 (0.3)

72 (0.2)

 

72 (0.2)

Death due to disaster (%)

94 (0.5)

34 (0.3)

128 (0.4)

 

128 (0.4)

Other causes (%)

1663 (8.8)

1111 (11.0)

2774 (9.5)

 

2774 (9.5)

Unspecified (%)

2012 (10.6)

956 (9.5)

2968 (10.2)

 

2968 (10.2)

Subtotal (%)

18,997 (100.0)

10,067 (100.0)

29,064 (100.0)

 

29,064 (100.0)

No information available

11

14

25

 

25

Total

19,008

10,081

29,089

 

29,089

The above data were obtained from the patient survey

Comparing mortality factors by age group (Fig. 13, Table 17), the ages at death among incident patients in 2015 increased, and deaths due to heart failure, infectious disease, and cachexia/uremia also increased. Particularly, among those aged 85 years or older, deaths from infectious disease reached 30.0%. This was largely the same trend seen in all mortality factors by age group for 2015 (Fig. 14, Table 18).
Figure 13
Fig. 13

Incident dialysis patient distribution, by cause of death and age, 2015

Table 17

Incident dialysis patient distribution, by cause of death and age, 2015

Cause of death

< 65

65 ≤, < 75

75 ≤, < 85

85 ≤

Subtotal

Unspecified

No information available

Total

Heart failure (%)

50 (19.8)

102 (20.7)

235 (26.9)

147 (27.2)

534 (24.7)

  

534 (24.7)

Cerebrovascular disorder (%)

14 (5.6)

41 (8.3)

51 (5.8)

18 (3.3)

124 (5.7)

  

124 (5.7)

Infectious disease (%)

59 (23.4)

118 (23.9)

218 (25.0)

162 (30.0)

557 (25.8)

  

557 (25.8)

Hemorrhage (%)

5 (2.0)

10 (2.0)

12 (1.4)

10 (1.9)

37 (1.7)

  

37 (1.7)

Malignant tumors (%)

44 (17.5)

78 (15.8)

86 (9.9)

28 (5.2)

236 (10.9)

  

236 (10.9)

Cachexia/uremia (%)

11 (4.4)

17 (3.4)

42 (4.8)

36 (6.7)

106 (4.9)

  

106 (4.9)

Cardiac infarction (%)

8 (3.2)

16 (3.2)

23 (2.6)

14 (2.6)

61 (2.8)

  

61 (2.8)

Potassium poisoning/sudden death (%)

6 (2.4)

7 (1.4)

14 (1.6)

4 (0.7)

31 (1.4)

  

31 (1.4)

Other causes (%)

32 (12.7)

63 (12.8)

126 (14.4)

93 (17.2)

314 (14.6)

  

314 (14.5)

Unspecified (%)

23 (9.1)

41 (8.3)

66 (7.6)

28 (5.2)

158 (7.3)

1 (100.0)

 

159 (7.4)

Subtotal (%)

252 (100.0)

493 (100.0)

873 (100.0)

540 (100.0)

2158 (100.0)

1 (100.0)

 

2159 (100.0)

No information available

1

 

1

1

3

  

3

Total

253

493

874

541

2161

1

 

2162

The above data were obtained from the patient survey

Figure 14
Fig. 14

Deceased dialysis patient distribution, by causes of death and age, 2015

Table 18

Deceased patient distribution, by causes of death and age, 2015

Cause of death

< 65

65 ≤, < 75

75 ≤, < 85

85 ≤

Subtotal

Unspecified

No information available

Total

Heart failure (%)

776 (22.0)

1960 (24.8)

2905 (26.2)

1901 (29.0)

7542 (26.0)

2 (18.2)

 

7544 (26.0)

Cerebrovascular disorder (%)

400 (11.3)

568 (7.2)

666 (6.0)

282 (4.3)

1916 (6.6)

  

1916 (6.6)

Infectious disease (%)

567 (16.0)

1716 (21.7)

2576 (23.3)

1533 (23.4)

6392 (22.0)

1 (9.1)

 

6393 (22.0)

Hemorrhage (%)

60 (1.7)

122 (1.5)

162 (1.5)

77 (1.2)

421 (1.4)

  

421 (1.4)

Malignant tumors (%)

377 (10.7)

911 (11.5)

1004 (9.1)

425 (6.5)

2717 (9.4)

  

2717 (9.3)

Cachexia/uremia (%)

72 (2.0)

248 (3.1)

521 (4.7)

498 (7.6)

1339 (4.6)

  

1339 (4.6)

Cardiac infarction (%)

215 (6.1)

392 (5.0)

452 (4.1)

186 (2.8)

1245 (4.3)

  

1245 (4.3)

Potassium poisoning/sudden death (%)

181 (5.1)

225 (2.9)

240 (2.2)

102 (1.6)

748 (2.6)

  

748 (2.6)

Other causes (%)

426 (12.1)

950 (12.0)

1465 (13.2)

929 (14.2)

3770 (13.0)

3 (27.3)

 

3774 (13.0)

Unspecified (%)

460 (13.0)

800 (10.1)

1078 (9.7)

625 (9.5)

2963 (10.2)

5 (45.5)

 

2968 (10.2)

Subtotal (%)

3534 (100.0)

7892 (100.0)

11,069 (100.0)

6558 (100.0)

29,053 (100.0)

11 (100.0)

 

29,064 (100.0)

No information available

3

6

8

8

25

  

25

Total

3537

7898

11,077

6566

29,078

11

 

29,089

The above data were obtained from the patient survey

Regarding the changes over time in the cause of death among patients who died during the incident year, heart failure was the most prevalent mortality factor in the 1990s, but infectious disease gradually rose to reach a percentage nearly the same as heart failure since mid-2000, and even exceeded heart failure. In 2015 as well, infectious disease was the most prevalent factor (25.8%), followed by heart failure as the second (24.7%). The order from the third most prevalent factor did not change: malignant tumor (10.9%), cerebrovascular disease (5.7%), and myocardial infarction (2.8%). Over the long term, death by cerebrovascular disease or myocardial infarction tended to decrease, whereas death due to infectious disease or malignancy tended to increase (Fig. 15, Table 19).
Figure 15
Fig. 15

Causes of death during the incident year, 1990–2015

Table 19

Causes of death during the incident year, 1990–2015

Cause of death

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Cardiac failure

32.3

33.4

32.6

32.3

30.0

26.9

22.6

23.4

24.4

23.3

22.8

26.0

24.6

Infectious disease

14.1

15.7

12.6

14.2

14.5

16.6

18.7

17.8

18.3

19.8

19.7

19.4

21.1

Cerebrovascular disease

10.8

9.5

8.8

8.9

8.6

9.5

8.2

9.2

7.4

7.1

7.3

8.2

7.4

Malignant tumor

8.6

7.4

7.5

7.5

8.4

7.8

9.1

9.0

6.4

8.3

9.2

9.3

9.3

Cardiac infarction

3.8

4.6

4.5

3.7

5.6

5.5

5.2

6.0

5.1

5.1

4.8

5.2

5.3

Cause of death

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Cardiac failure

23.9

23.3

24.3

22.8

23.2

24.1

21.8

24.9

25.0

25.5

23.8

23.8

24.7

Infectious disease

23.8

23.6

23.7

26.4

24.2

25.2

26.1

26.5

24.5

25.7

26.0

25.8

25.8

Cerebrovascular disease

7.6

6.3

6.5

5.9

5.5

5.1

5.4

4.8

5.4

5.2

6.1

4.5

5.7

Malignant tumor

9.5

9.1

9.4

10.4

10.3

9.8

10.4

12.5

11.6

10.6

12.1

11.4

10.9

Cardiac infarction

4.2

3.8

3.8

3.2

3.5

2.8

3.5

3.0

3.5

2.8

3.0

3.3

2.8

The above data were obtained from the patient survey

As for overall dialysis patients’ changes in cause of death over time, death by infectious disease has consistently increased since 1993. Although its rate of increase slowed until last year, this year it again increased by 1.1%. Cerebrovascular disease has been consistently on a gradual decrease since 1994. Recently, myocardial infarction-related deaths have been on a gradually decreasing trend from a peak of 8.4% in 1997. The deaths from malignant tumor have gradually increased starting from 5.8% at the end of 1987, but have remained roughly level since reaching approximately 9.0% in 2004. Categorizing deaths due to heart failure, cerebrovascular disease, and myocardial infarction as cardiovascular deaths, they represented 54.8% of the total in 1988, and then decreased at a largely fixed pace, reaching 36.0% in 2009 (Fig. 16, Table 20). Furthermore, the cause of death category codes in this survey have been greatly revised at two points, the 2003 and the 2010 JRDR survey (see the 2010 JRDR report for details of the revisions [9]).
Figure 16
Fig. 16

Major causes of death, 1983–2015

Table 20

Major causes of death, 1983–2015

Cause of death

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Cardiac failure

30.3

30.5

31.3

33.2

32.7

36.5

33.4

30.4

30.5

31.1

29.9

28.2

25.4

24.1

23.9

24.1

24.3

Infectious disease

11.0

11.5

11.5

12.0

12.0

12.2

11.7

11.6

12.1

11.3

12.2

12.6

13.8

14.6

14.9

15.0

16.3

Cerebrovascular disease

14.2

15.4

14.2

14.0

14.2

12.9

13.2

13.9

13.7

13.6

13.5

14.1

13.5

12.9

12.6

12.1

11.3

Malignant tumor

7.7

6.9

6.4

6.9

5.8

6.9

7.6

8.2

7.6

7.1

7.4

7.3

7.2

7.7

8.1

7.7

7.6

Cardiac infarction

5.3

4.8

5.3

6.1

6.0

5.4

5.3

5.8

5.8

5.8

5.7

7.1

7.5

7.4

8.4

7.9

7.4

Cause of death

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

 

Cardiac failure

23.2

25.5

25.1

25.0

25.1

25.8

24.9

24.0

23.7

23.6

27.0

26.6

27.2

26.8

26.3

26.0

 

Infectious disease

16.6

16.3

15.9

18.5

18.8

19.2

19.9

18.9

19.9

20.7

20.3

20.3

20.4

20.8

20.9

22.0

 

Cerebrovascular disease

11.3

11.6

11.2

10.7

10.6

9.8

9.4

8.9

8.6

8.4

8.1

7.7

7.5

7.2

7.1

6.6

 

Malignant tumor

8.3

8.5

8.5

8.5

9.0

9.0

9.2

9.2

9.2

9.4

9.8

9.1

9.1

9.4

9.0

9.3

 

Cardiac infarction

7.0

7.4

7.4

6.2

5.4

5.1

4.4

4.4

4.1

4.0

4.7

4.6

4.5

4.3

4.3

4.3

 

The above data were obtained from the patient survey

Crude death rate and survival rate

We calculated the annual crude death rate from patient dynamics in the facility survey. Because incident patients increased in age and included greater numbers of those with diabetic nephropathy and those with poor prognosis due to nephrosclerosis or other factors, the crude death rate tended to worsen annually. The lowest crude death rate was 7.9% in 1989, a year with a low questionnaire response rate. However, the rate exceeded 9.0% as 9.7% in 1992 and has remained approximately 9.2% to 9.8% since then, reaching 9.6% in 2015 (Table 21).
Table 21

Annual crude death rate, 1983–2015

 

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Crude death rate (%)

9.0

8.9

9.1

9.0

8.5

9.2

7.9

9.6

8.9

9.7

9.4

9.5

9.7

9.4

9.4

9.2

9.7

 

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

 

Crude death rate (%)

9.2

9.3

9.2

9.3

9.4

9.5

9.2

9.4

9.8

9.6

9.8

10.2

10.0

9.8

9.7

9.6

 

The above data were obtained from the facility survey

At of the end of 2015, the survival rate was 89.9% for 1-year survival of 35,864 patients who initiated dialysis in 2014, 60.8% for five-year survival of patients who initiated dialysis in 2010, 35.9% for 10-year survival of patients who initiated dialysis in 2005, 23.5% for 15-year survival of patients who initiated dialysis in 2000, 15.4% for 20-year survival of patients who initiated dialysis in 1995, and 11.8% for 25-year survival of patients who initiated dialysis in 1990. Concerning the individual changes in survival rate over time, the short-term prognosis for 1- and 5-year vintage dialysis patients continuously improved, even though the number of elderly diabetic patients increased (Fig. 17, Additional file 1: Table S1).
Figure 17
Fig. 17

1-, 5-, 10-, 15-, 20-, 25-, and 30-year survival rate, 1983–2014

Chapter 2: current status of dialysis fluid quality management

Overview of dialysis fluid quality

In the JRDR survey, a survey was started from the end of 2006 on microbiological quality of dialysis fluid and its management. Based on the results, the JSDT standard for dialysis fluid microbial quality was revised in 2008 [10]. In this standard, dialysis fluid microbial quality should be evaluated based on both ET concentration and total viable microbial count (TVC). These both should be evaluated more frequently than once monthly. At least two bedside consoles should be tested in every month, and all consoles were tested a minimum of once annually. The required minimum quality used in dialysis therapy was defined as “standard dialysis fluid” with a dialysis fluid ET concentration < 0.05 EU/mL, and TVC < 100 cfu/mL. “Ultra-pure dialysis fluid (UPD)” is defined as having a dialysis fluid ET concentration < 0.001 EU/mL (less than the detectable limit), and TVC < 0.1 cfu/mL. JSDT recommended the use of UPD for all dialysis therapies. At the time these standards were adopted, as well as in 2016, they were the strictest criteria in the world. Furthermore, in the 2010 revision of the medical payment system, dialysis fluid quality was newly added, and thus, dialysis fluid quality control dramatically improved from the 2010 survey [9]. In 2015, dialysis fluid ET concentration and dialysis patient prognosis were analyzed using the JRDR data, and the patient group that was being treated at facilities with a dialysis fluid ET concentration < 0.001 EU/mL reportedly had a clearly higher 1-year survival rate than the patient group undergoing treatment at facilities with a concentration of 0.100 EU/mL or higher [11]. The dialysis fluid quality and its control were evaluated in 4303 facilities which had one or more bedside consoles in the 2015 survey.

Dialysis fluid ET testing

Dialysis fluid ET concentration is recommended to be measured by limulus tests in the JSDT standard [9]. In Japan, these ET assay systems are available at a relatively low cost and are widely used in most dialysis facilities. However, this situation is quite unique in the world. In a total of 4303, facilities had one or more bedside consoles, wherein 4233 facilities (98.4%) responded with their dialysis fluid ET assay frequency. These include 3424 facilities (80.9%) satisfying the once monthly or more rule in the standard (Fig. 18, Table 22). The data for dialysis fluid ET concentrations were obtained from 4109 facilities (95.5%). Among them, 3268 facilities (79.5%) attained ET concentration of the < 0.001 EU/mL guaranteed by UPD and 3986 facilities (97.1%) reached ET < 0.050 EU/mL guaranteed by standard dialysis fluid (Fig. 19, Table 22). As for the changes over time in dialysis fluid ET concentration testing frequency, the results were 33.1% in 2008 when water quality standards were enacted [11], which then stepped up to 70.6% in 2010 when water quality management has started being reimbursed and thereafter has gradually increased [8] (Fig. 20, Table 23). Regarding annual changes in dialysis fluid ET concentration, both the level guaranteed by UPD and the level guaranteed by standard dialysis fluid have changed over time (Fig. 21, Table 24). The decrease in dialysis fluid ET concentration in 2008 is due to the switch in dialysis fluid ET concentration units from EU/L to EU/mL based on international rules, and many incorrect entries were found.
Figure 18
Fig. 18

Facility distribution, by endotoxin measurement frequency, 2015

Table 22

Facility distribution, by endotoxin measurement frequency and concentration, 2015

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 (%)

18 (0.6)

131 (4.0)

227 (7.0)

2387 (73.1)

261 (8.0)

241 (7.4)

1 (0.0)

3266 (100.0)

2

 

3268

0.001 ≤, < 0.01 (%)

1 (0.2)

18 (3.5)

23 (4.5)

372 (73.1)

58 (11.4)

37 (7.3)

 

509 (100.0)

  

509

0.01 ≤, < 0.05 (%)

 

6 (2.9)

13 (6.2)

139 (66.5)

26 (12.4)

25 (12.0)

 

209 (100.0)

  

209

0.05 ≤, < 0.1 (%)

 

2 (3.6)

3 (5.5)

32 (58.2)

7 (12.7)

11 (20.0)

 

55 (100.0)

  

55

0.1 ≤, < 0.25 (%)

1 (3.0)

2 (6.1)

 

22 (66.7)

5 (15.2)

3 (9.1)

 

33 (100.0)

  

33

0.25 ≤, < 0.5 (%)

  

1 (5.6)

11 (61.1)

3 (16.7)

3 (16.7)

 

18 (100.0)

1

 

19

0.5 ≤ (%)

  

1 (6.3)

11 (68.8)

1 (6.3)

3 (18.8)

 

16 (100.0)

  

16

Subtotal (%)

20 (0.5)

159 (3.9)

268 (6.5)

2974 (72.4)

361 (8.8)

323 (7.9)

1 (0.0)

4106 (100.0)

3

 

4109

Unspecified (%)

1 (1.4)

  

2 (2.8)

6 (8.5)

2 (2.8)

60 (84.5)

71 (100.0)

60

 

131

No information available (%)

      

56 (100.0)

56 (100.0)

 

7

63

Total (%)

21 (0.5)

159 (3.8)

268 (6.3)

2976 (70.3)

367 (8.7)

325 (7.7)

117 (2.8)

4233 (100.0)

63

7

4303

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

Figure 19
Fig. 19

Facility distribution, by endotoxin concentration, 2015

Figure 20
Fig. 20

Facility distribution, by endotoxin measurement frequency, 2006–2015

Table 23

Facility distribution, by endotoxin measurement frequency, 2006–2015

Frequency of measurement (per month)

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

1 ≤ (%)

953 (27.3)

1153 (31.5)

1253 (33.1)

1373 (36.0)

2810 (70.6)

2914 (71.9)

3141 (76.3)

3238 (77.7)

3329 (78.7)

3424 (80.9)

< 1 (%)

2535 (72.7)

2511 (68.5)

2531 (66.9)

2436 (64.0)

1170 (29.4)

1137 (28.1)

977 (23.7)

929 (22.3)

900 (21.3)

809 (19.1)

Subtotal (%)

3488 (100.0)

3664 (100.0)

3784 (100.0)

3809 (100.0)

3980 (100.0)

4051 (100.0)

4118 (100.0)

4167 (100.0)

4229 (100.0)

4233 (100.0)

Unspecified

185

209

244

193

92

99

77

65

69

63

No information available

312

179

53

48

52

27

8

3

6

7

Total

3985

4052

4081

4050

4124

4177

4203

4235

4304

4303

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

Figure 21
Fig. 21

Facility distribution, by endotoxin concentration, 2006–2015

Table 24

Facility distribution, by endotoxin concentration, 2006–2015

Endotoxin concentration in dialysis fluid (EU/ml)

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

< 0.001 (%)

817 (29.8)

1688 (53.0)

1865 (56.1)

2343 (62.1)

2549 (66.0)

2787 (70.7)

2963 (73.9)

3167 (77.6)

3268 (79.5)

0.001 ≤, < 0.05 (%)

1627 (59.2)

1295 (40.6)

933 (28.1)

1115 (29.6)

1042 (27.0)

938 (23.8)

849 (21.2)

759 (18.6)

718 (17.5)

0.05 ≤ (%)

302 (11.0)

203 (6.4)

527 (15.8)

314 (8.3)

271 (7.0)

216 (5.5)

195 (4.9)

153 (3.8)

123 (3.0)

Subtotal (%)

2746 (100.0)

3186 (100.0)

3325 (100.0)

3772 (100.0)

3862 (100.0)

3941 (100.0)

4007 (100.0)

4079 (100.0)

4109 (100.0)

Unspecified

215

253

105

112

197

148

164

131

No information available

1239

651

472

247

203

65

80

61

63

Total

3985

4052

4050

4124

4177

4203

4235

4304

4303

The unit of endotoxin in the questionnaire has changed in 2008. The data of the year were omitted because of the potentially higher rate of erroneous results

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

Dialysis fluid viable microbial testing

Dialysis fluid viable microbial testing was performed by TVC, the number of colonies after the 7-day cultivation at 17 to 23 °C using a heterotrophic agar plate medium [9]. A total of 4212 facilities (97.9%) responded with their dialysis fluid TVC assay frequency, which included 3189 facilities (75.7%) satisfying the once monthly or more rule in the JSDT standard (Fig. 22, Table 25). A total of 3966 facilities (92.2%) responded with their dialysis fluid TVC, with 2905 facilities (73.2%) reaching the < 0.1 cfu/mL guaranteed by the UPD and 3940 facilities (99.4%) reaching the < 100 cfu/mL guaranteed by the standard dialysis fluid (Fig. 23, Table 25).
Figure 22
Fig. 22

Facility distribution, by TVC measurement frequency, 2015. Abbreviation: TVC, total viable microbial count

Figure 23
Fig. 23

Facility distribution, by TVC, 2015. Abbreviation: TVC, total viable microbial count

Table 25

Facility distribution, by microbial measurement frequency and TVC

TVC (cfu/mL)

Every day

Every week

Every 2 week

Every month

Several times per year

Once a year

None

Subtotal

Unspecified

No information available

Total

< 0.1 (%)

11 (0.4)

99 (3.4)

194 (6.7)

2013 (69.4)

278 (9.6)

306 (10.5)

1 (0.0)

2902 (100.0)

3

 

2905

0.1 ≤, < 1 (%)

 

11 (2.3)

25 (5.1)

351 (72.1)

46 (9.4)

54 (11.1)

 

487 (100.0)

2

 

489

1 ≤, < 10 (%)

1 (0.3)

15 (3.9)

22 (5.7)

281 (72.6)

39 (10.1)

29 (7.5)

 

387 (100.0)

  

387

10 ≤, < 100 (%)

 

5 (3.1)

9 (5.6)

108 (67.1)

22 (13.7)

17 (10.6)

 

161 (100.0)

  

161

100 ≤ (%)

1 (4.2)

  

18 (75.0)

1 (4.2)

4 (16.7)

 

24 (100.0)

  

24

Subtotal (%)

13 (0.3)

130 (3.3)

250 (6.3)

2771 (70.0)

386 (9.7)

410 (10.4)

1 (0.0)

3961 (100.0)

5

 

3966

Unspecified (%)

 

1 (0.7)

2 (1.4)

21 (14.2)

10 (6.8)

10 (6.8)

104 (70.3)

148 (100.0)

79

 

227

No information available (%)

   

1 (1.0)

  

102 (99.0)

103 (100.0)

 

7

110

Total (%)

13 (0.3)

131 (3.1)

252 (6.0)

2793 (66.3)

396 (9.4)

420 (10.0)

207 (4.9)

4212 (100.0)

84

7

4303

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

TVC testing frequency increased annually, and although it increased in 2010 similar to the ET assay, its frequency was always slightly lower than ET (Fig. 24, Table 26). The changes over time in dialysis fluid TVC indicated that the level guaranteed by UPD and the level guaranteed by standard dialysis fluid have increased over time, which is similar to dialysis fluid ET concentration (Fig. 25, Table 27).
Figure 24
Fig. 24

Facility distribution, by TVC measurement frequency, 2006–2015. Abbreviation: TVC, total viable microbial count

Table 26

Facility distribution, by TVC measurement frequency, 2006–2015

Frequency of measurement (per month)

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

1 ≤ (%)

371 (11.5)

580 (16.9)

751 (20.8)

934 (25.8)

2649 (67.8)

2794 (70.0)

3018 (73.7)

3091 (74.7)

3148 (74.8)

3189 (75.7)

< 1 (%)

2857 (88.5)

2861 (83.1)

2856 (79.2)

2693 (74.2)

1260 (32.2)

1196 (30.0)

1077 (26.3)

1046 (25.3)

1059 (25.2)

1023 (24.3)

Subtotal (%)

3228 (100.0)

3441 (100.0)

3607 (100.0)

3627 (100.0)

3909 (100.0)

3990 (100.0)

4095 (100.0)

4137 (100.0)

4207 (100.0)

4212 (100.0)

Unspecified

386

412

418

367

158

159

100

94

90

84

No information available

371

199

56

56

57

28

8

4

7

7

Total

3985

4052

4081

4050

4124

4177

4203

4235

4304

4303

Abbreviation: TVC total viable microbial count

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

Figure 25
Fig. 25

Facility distribution, by TVC, 2006–2015. Abbreviation: TVC, total viable microbial count

Table 27

Facility distribution, by TVC, 2006–2015

TVC (cfu/mL)

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

< 0.1 (%)

508 (48.4)

750 (47.9)

915 (50.7)

1123 (54.5)

1819 (53.1)

2017 (56.4)

2397 (63.8)

2570 (67.1)

2811 (71.5)

2905 (73.2)

0.1 ≤, < 100 (%)

509 (48.5)

775 (49.5)

847 (46.9)

901 (43.7)

1542 (45.0)

1498 (41.9)

1305 (34.7)

1214 (31.7)

1079 (27.5)

1037 (26.1)

100 ≤ (%)

32 (3.1)

40 (2.6)

43 (2.4)

38 (1.8)

62 (1.8)

62 (1.7)

55 (1.5)

46 (1.2)

40 (1.0)

24 (0.6)

Subtotal (%)

1049 (100.0)

1565 (100.0)

1805 (100.0)

2062 (100.0)

3423 (100.0)

3577 (100.0)

3757 (100.0)

3830 (100.0)

3930 (100.0)

3966 (100.0)

Unspecified

2036

552

575

494

216

227

320

273

264

227

No information available

900

1935

1701

1494

485

373

126

132

110

110

Total

3985

4052

4081

4050

4124

4177

4203

4235

4304

4303

Abbreviation: TVC total viable microbial count

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

As described above, the JSDT standard recommend the use of a certified bacterial culture medium such as R2A, TGEA, or one with similar sensitivity [9]. In general, in methods using an agar plate medium, such as R2A or TGEA, a 0.5-mL sample size is the limit to guarantee a 100 cfu/mL standard dialysis fluid. On the other hand, to guarantee the UPD standard of < 0.1 cfu/mL, a minimum of 10 mL or more of dialysis fluid must be sampled and cultured after being strained through a membrane filter. Thus, the JRDR survey examined the sampling volume of dialysis fluid as well as the type of culture medium used. In the 2015 survey, 3879 of 4303 facilities (90.1%) responded regarding the medium for TVC (Fig. 26, Table 28), 56.4% and 30.4% of facilities used R2A and TGEA, respectively. Thus, 86.8% of facilities satisfied quality standards. Of 4303 facilities, 3986 (92.6%) responded regarding the sampling volume. In the 2015 survey, 79.2% of facilities sampled 10 mL or more dialysis fluid for the UPD guarantee (Fig. 27, Table 28). The trend of the types of medium used for TVC indicates that the numbers of facilities using TEGA are increasing, while the facilities using R2A are decreasing. In total, an overall increase in satisfying the standard has been observed (Fig. 28, Table 29). The sampling volume for TVC assay guaranteeing UPD has been gradually increasing (Fig. 29, Table 30).
Figure 26
Fig. 26

Facility distribution, by cultivation medium, 2015. (1). R2A, Reasoner’s No. 2 agar. (2) TGEA, tryptone glucose extract agar. (3) TSA, trypticase soy agar

Table 28

Facility distribution on TVC measurement, by cultivation medium and sampling volume, 2015

Sampling volume

R2A

TGEA

Nutrient agar

Blood agar

TSA

Others

Subtotal

Unspecified

No information available

Total

< 1 (%)

166 (58.7)

37 (13.1)

63 (22.3)

2 (0.7)

6 (2.1)

9 (3.2)

283 (100.0)

20

1

304

1 ≤, < 10 (%)

354 (73.8)

32 (6.7)

60 (12.5)

9 (1.9)

3 (0.6)

22 (4.6)

480 (100.0)

44

 

524

10 ≤, < 50 (%)

649 (55.0)

363 (30.8)

83 (7.0)

7 (0.6)

5 (0.4)

72 (6.1)

1179 (100.0)

31

 

1210

50 ≤, < 100 (%)

721 (50.2)

591 (41.2)

38 (2.6)

3 (0.2)

16 (1.1)

66 (4.6)

1435 (100.0)

18

 

1453

100 ≤, < 500 (%)

272 (59.6)

145 (31.8)

12 (2.6)

1 (0.2)

3 (0.7)

23 (5.0)

456 (100.0)

5

 

461

500 ≤, < 1000 (%)

11 (68.8)

5 (31.3)

    

16 (100.0)

  

16

1000 ≤, < 10,000 (%)

8 (50.0)

6 (37.5)

1 (6.3)

  

1 (6.3)

16 (100.0)

  

16

10,000 ≤ (%)

1 (50.0)

1 (50.0)

    

2 (100.0)

  

2

Subtotal (%)

2182 (56.4)

1180 (30.5)

257 (6.6)

22 (0.6)

33 (0.9)

193 (5.0)

3867 (100.0)

118

1

3986

Unspecified (%)

5 (45.5)

 

6 (54.5)

   

11 (100.0)

195

1

207

No information available (%)

1 (100.0)

     

1 (100.0)

 

109

110

Total (%)

2188 (56.4)

1180 (30.4)

263 (6.8)

22 (0.6)

33 (0.9)

193 (5.0)

3879 (100.0)

313

111

4303

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

Figure 27
Fig. 27

Facility distribution, by sampling volume for TVC measurement, 2015. Abbreviation: TVC, total viable microbial count

Figure 28
Fig. 28

Facility distribution, by cultivation medium, 2006–2015. (1) R2A, Reasoner’s No. 2 agar. (2) TGEA, tryptone glucose extract agar. (3) TSA, trypticase soy agar

Table 29

Facility distribution, by cultivation medium, 2006–2015

Cultivation medium

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

R2A (%)

746 (67.5)

1028 (66.3)

1175 (65.5)

1324 (64.2)

2130 (63.9)

2213 (63.5)

2193 (59.8)

2148 (57.7)

2142 (55.8)

2188 (56.4)

TGEA (%)

36 (3.3)

111 (7.2)

205 (11.4)

292 (14.2)

669 (20.1)

745 (21.4)

944 (25.8)

1051 (28.2)

1169 (30.4)

1180 (30.4)

Nutrient agar (%)

170 (15.4)

220 (14.2)

235 (13.1)

246 (11.9)

246 (7.4)

266 (7.6)

244 (6.7)

273 (7.3)

275 (7.2)

263 (6.8)

Blood agar (%)

48 (4.3)

52 (3.4)

42 (2.3)

37 (1.8)

23 (0.7)

22 (0.6)

21 (0.6)

15 (0.4)

15 (0.4)

22 (0.6)

TSA (%)

4 (0.4)

9 (0.6)

16 (0.9)

12 (0.6)

19 (0.6)

23 (0.7)

32 (0.9)

27 (0.7)

36 (0.9)

33 (0.9)

Others (%)

102 (9.2)

131 (8.4)

120 (6.7)

150 (7.3)

246 (7.4)

217 (6.2)

231 (6.3)

210 (5.6)

203 (5.3)

193 (5.0)

Subtotal (%)

1106 (100.0)

1551 (100.0)

1793 (100.0)

2061 (100.0)

3333 (100.0)

3486 (100.0)

3665 (100.0)

3724 (100.0)

3840 (100.0)

3879 (100.0)

Unspecified

2023

1720

1622

1448

584

531

411

375

353

313

No information available

856

781

666

541

207

160

127

136

111

111

Total

3985

4052

4081

4050

4124

4177

4203

4235

4304

4303

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

R2A Reasoner’s No. 2 agar, TGEA tryptone glucose extract agar, TSA trypticase soy agar

Figure 29
Fig. 29

Facility distribution, by sample volume for TVC measurement, 2006–2015. Abbreviation: TVC, total viable microbial count

Table 30

Facility distribution, by sampling volume for TVC measurement, 2006–2015

Sampling volume

2007

2008

2009

2010

2011

2012

2013

2014

2015

< 10 (%)

886 (53.5)

911 (48.0)

921 (42.8)

1208 (34.8)

1176 (32.5)

948 (25.1)

885 (23.0)

905 (22.9)

828 (20.8)

10 ≤ (%)

771 (46.5)

987 (52.0)

1229 (57.2)

2262 (65.2)

2440 (67.5)

2827 (74.9)

2969 (77.0)

3045 (77.1)

3158 (79.2)

Subtotal (%)

1657 (100.0)

1898 (100.0)

2150 (100.0)

3470 (100.0)

3616 (100.0)

3775 (100.0)

3854 (100.0)

3950 (100.0)

3986 (100.0)

Unspecified

1603

1519

1362

452

405

303

250

244

207

No information available

792

664

538

202

156

125

131

110

110

Total

4052

4081

4050

4124

4177

4203

4235

4304

4303

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

Present status of ETRF installation

Installation of an ETRF is indispensable for maintaining dialysis fluid quality within UPD level, and JSDT established the standard for the management of ETRF [12]. Of 4303 facilities with one or more bedside consoles, 4294 facilities (99.8%) responded regarding ETRF installation. Among them, 4172 facilities (97.2%) installed ETRF in one or more bedside consoles (Table 31). Of 133,538 bedside consoles in 4303 facilities, 121,014 consoles (90.6%) had an ETRF installed (Table 32). The usage of ETRF at sampling has strong impacts on the results of ET concentration and TVC. The percentages of the facilities satisfying UPD standard in “Use” of ETRF were higher than those in “None-use” (Figs. 30 and 31, Tables 33 and 34). One process of ETRF can theoretically attain the UPD standard of both ET concentration and TVC, unless the contamination of dialysis fluid immediately before ETRF is extremely severe. However, even when an ETRF was installed, neither a 19.1% ET concentration nor a 24.8% TVC satisfied the UPD standard. These results suggest that the spread of ETRF has contributed to the improvement of dialysis fluid quality and that there are issues in the handling of ETRF to achieve UPD [12].
Table 31

Facility counts, by ETRF installation, 2015

 

With ETRF

Without ETRF

Subtotal

No information available

Total

Number of facilities (%)

4172 (97.2)

122 (2.8)

4294 (100.0)

9

4303

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

Table 32

Bedside console counts, by ETRF installation, 2015

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 (%)

121,014 (100.0)

0 (0.0)

121,014 (100.0)

0

121,014

Number of bedside consoles without ETRF (%)

10,008 (81.4)

2286 (18.6)

12,294 (100.0)

230

12,524

Total (%)

131,022 (98.3)

2286 (1.7)

133,308 (100.0)

230

133,538

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

ETRF endotoxin retentive filter

Figure 30
Fig. 30

Facility distribution, by ETRF installation during sampling endotoxin concentration, 2015. Abbreviation: ETRF, endotoxin retentive filter

Figure 31
Fig. 31

Facility distribution, by ETRF installation during sampling TVC, 2015. Abbreviation: ETRF, endotoxin retentive filter

Table 33

Facility distribution, by ETRF installation during sampling endotoxin concentration, 2015

With or without ETRF when the dialysate 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

With ETRF (%)

2895 (80.9)

421 (11.8)

161 (4.5)

46 (1.3)

25 (0.7)

16 (0.4)

14 (0.4)

3578 (100.0)

28

3

3609

Without ETRF (%)

363 (71.2)

86 (16.9)

41 (8.0)

8 (1.6)

7 (1.4)

3 (0.6)

2 (0.4)

510 (100.0)

54

27

591

Subtotal (%)

3258 (79.7)

507 (100.0)

202 (100.0)

54 (100.0)

32 (100.0)

19 (100.0)

16 (100.0)

4088 (100.0)

82

30

4200

Unspecified (%)

10 (47.6)

2 (9.5)

7 (33.3)

1 (4.8)

1 (4.8)

(0.0)

(0.0)

21 (100.0)

48

7

76

No information available (%)

        

1

26

27

Total (%)

3268 (79.5)

509 (12.4)

209 (5.1)

55 (1.3)

33 (0.8)

19 (0.5)

16 (0.4)

4109 (100.0)

131

63

4303

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

ETRF endotoxin retentive filter

Table 34

Facility distribution, by ETRF installation during sampling and TVC, 2015

With or without ETRF when the dialysate sampled

< 0.1

0.1 ≤, < 1

1 ≤, < 10

10 ≤, < 100

100 ≤

Subtotal

Unspecified

No information available

Total

With ETRF (%)

2600 (75.2)

407 (11.8)

316 (9.1)

115 (3.3)

20 (0.6)

3458 (100.0)

113

38

3609

Without ETRF (%)

297 (61.1)

77 (15.8)

67 (13.8)

41 (8.4)

4 (0.8)

486 (100.0)

67

38

591

Subtotal (%)

2897 (73.5)

484 (12.3)

383 (9.7)

156 (4.0)

24 (0.6)

3944 (100.0)

180

76

4200

Unspecified

8 (36.4)

5 (22.7)

4 (18.2)

5 (22.7)

(0.0)

22 (100.0)

46

8

76

No information available

      

1

26

27

Total

2905 (73.2)

489 (12.3)

387 (9.8)

161 (4.1)

24 (0.6)

3966 (100.0)

227

110

4303

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

Overall dialysis fluid quality

The JSDT standard requires facilities to satisfy both dialysis fluid ET concentration and TVC simultaneously within UPD or dialysis fluid standard, in order to maintain the microbiological quality of dialysis fluid [9]. Of 4303 facilities, 3959 (92.0%) responded about both their dialysis fluid ET concentration and TVC. These included 2704 facilities (68.3%) that achieved UPD and 3833 facilities (96.8%) that achieved a standard dialysis fluid (Fig. 32, Table 35). Figure 33 shows the annual changes in the achievement rate of UPD and standard dialysis fluid computed from facilities that responded with both ET concentration and TVC, which has improved since 2009 (Fig. 33, Table 36).
Figure 32
Fig. 32

Facility distribution, by TVC and endotoxin concentration, 2015. Abbreviation: TVC, total viable microbial count

Table 35

Facility distribution, by TVC and endotoxin concentration, 2015

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

2704

144

37

8

4

4

2

2903

2

 

2905

0.1 ≤, < 1

269

155

44

9

3

4

2

486

3

 

489

1 ≤, < 10

160

128

59

19

15

3

1

385

1

1

387

10 ≤, < 100

41

51

41

14

5

4

5

161

  

161

100 ≤

7

5

5

 

2

2

3

24

  

24

Subtotal

3181

483

186

50

29

17

13

3959

6

1

3966

Unspecified

61

18

15

3

3

1

2

103

123

1

227

No information available

26

8

8

2

1

1

1

47

2

61

110

Total

3268

509

209

55

33

19

16

4109

131

63

4303

TVC total viable microbial count

Figure 33
Fig. 33

Facility distribution, in achievement of UPD and standard dialysis fluid, 2009–2015. Abbreviation: UPD, ultrapure dialysis fluid

Table 36

Facility distribution, in achievement of UPD and standard dialysis fluid, 2009–2015

 

2009

2010

2011

2012

2013

2014

2015

The facilities with both ET < 0.001 EU/ml and TVC < 0.1 cfu/mL (%)

866 (43.1)

1512 (44.4)

1735 (48.7)

2152 (57.5)

2325 (60.8)

2602 (66.4)

2704 (68.3)

The facilities with both ET < 0.05 EU/mL and TVC < 100 cfu/mL (%)

1725 (85.9)

3124 (91.8)

3307 (92.8)

3525 (94.2)

3624 (94.8)

3753 (95.8)

3833 (96.8)

cfu colony forming unit, ET endotoxin concentration, EU endotoxin unit, TVC total viable microbial count, UPD ultrapure dialysis fluid

Chapter 3: Current status of HDF

HDF patient dynamics

Hemodiafiltration (HDF) includes several variations as online HDF, offline HDF, push/pull HDF, acetate-free biofiltration (AFBF), and intermittent infusion hemodiafiltration (IHDF). The patients treated by HDF in Japan rapidly increased year by year and reached 53,776 by the end of 2015, accounting for 17.8% of all HD/HDF patients (Fig. 34, Table 37). Of 53,776 HDF patients, 34,316 (63.8%) were males and 19,460 (36.2%) were females (Fig. 35, Table 38). The mean age was 64.8 years for males and 66.9 years for females; the age category with the greatest percentage being ages 65 to 69 years. These distributions and trends resembled those of HD patients (Fig. 3), and HDF therapy was being performed for various ages. Concerning the main primary disease in HDF patients, diabetic nephropathy and chronic glomerulonephritis accounted for 34.1 and 35.2%, respectively. Comparing HD patients, the percentage of diabetic nephropathy was low, and the percentage of chronic glomerulonephritis was high (Fig. 36, Table 39). The distribution of dialysis vintages was largely the same as that for HD patients (Fig. 6) (Fig. 37, Table 40). Males tended to be more numerous in each age category, although the number of male and female patients was largely the same for dialysis vintages of 25 years or longer.
Figure 34
Fig. 34

Prevalent dialysis patient distribution, by HDF modality, 2009–2015. Abbreviations: HDF, hemodiafiltration; AFBF, acetate-free biofiltration; IHDF, intermittent infusion hemodiafiltration

Table 37

Prevalent patient distribution, by HDF modality, 2009–2015

Dialysis modality

2009

2010

2011

2012

2013

2014

2015

Facility HD

253,807

262,973

270,072

268,275

264,211

255,641

248,725

Online HDF (%)

6852 (40.7)

4829 (32.5)

4890 (34.6)

14,069 (64.8)

23,536 (75.0)

36,090 (83.4)

44,527 (82.8)

Offline HDF (%)

9299 (55.2)

9421 (63.4)

8573 (60.7)

7157 (32.9)

7149 (22.8)

6315 (14.6)

5332 (9.9)

Push/Pull HDF (%)

237 (1.4)

159 (1.1)

145 (1.0)

109 (0.5)

263 (0.8)

537 (1.2)

110 (0.2)

AFBF (%)

465 (2.8)

458 (3.1)

507 (3.6)

390 (1.8)

423 (1.3)

341 (0.8)

267 (0.5)

IHDF (%)

      

3540 (6.6)

HDF subtotal (%)

16,853 (100.0)

14,867 (100.0)

14,115 (100.0)

21,725 (100.0)

31,371 (100.0)

43,283 (100.0)

53,776 (100.0)

HD·HDF total

270,660

277,840

284,187

290,000

295,582

298,924

302,501

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

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

HD hemodialysis, HDF hemodiafiltration

Figure 35
Fig. 35

HDF patient distribution, by age and sex, 2015

Table 38

HDF patient distribution, by age and sex, 2015

Sex

< 10

10 ≤, < 15

15 ≤, < 20

20 ≤, < 25

25 ≤, < 30

30 ≤, < 35

35 ≤, < 40

40 ≤, < 45

45 ≤, < 50

50 ≤, < 55

55 ≤, < 60

60 ≤, < 65

65 ≤, < 70

70 ≤, < 75

75 ≤, < 80

80 ≤, < 85

85 ≤, < 90

90 ≤, < 95

95 ≤

Subtotal

No information available

Total

Mean age

S.D.

Male (%)

 

1 (0.0)

7 (0.0)

21 (0.1)

110 (0.3)

252 (0.7)

602 (1.8)

1330 (3.9)

2061 (6.0)

2789 (8.1)

3381 (9.9)

4661 (13.6)

6372 (18.6)

4928 (14.4)

3824 (11.1)

2552 (7.4)

1122 (3.3)

280 (0.8)

23 (0.1)

34,316 (100.0)

 

34,316

64.81

12.47

Female (%)

  

5 (0.0)

15 (0.1)

56 (0.3)

105 (0.5)

229 (1.2)

597 (3.1)

896 (4.6)

1277 (6.6)

1693 (8.7)

2605 (13.4)

3641 (18.7)

2872 (14.8)

2388 (12.3)

1776 (9.1)

986 (5.1)

278 (1.4)

41 (0.2)

19,460 (100.0)

 

19,460

66.86

12.41

Subtotal (%)

 

1 (0.0)

12 (0.0)

36 (0.1)

166 (0.3)

357 (0.7)

831 (1.5)

1927 (3.6)

2957 (5.5)

4066 (7.6)

5074 (9.4)

7266 (13.5)

10,013 (18.6)

7800 (14.5)

6212 (11.6)

4328 (8.0)

2108 (3.9)

558 (1.0)

64 (0.1)

53,776 (100.0)

 

53,776

65.55

12.48

No information available

                      

0

0

Total (%)

 

1 (0.0)

12 (0.0)

36 (0.1)

166 (0.3)

357 (0.7)

831 (1.5)

1927 (3.6)

2957 (5.5)

4066 (7.6)

5074 (9.4)

7266 (13.5)

10,013 (18.6)

7800 (14.5)

6212 (11.6)

4328 (8.0)

2108 (3.9)

558 (1.0)

64 (0.1)

53,776 (100.0)

 

53,776

65.55

12.48

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

Figure 36
Fig. 36

Dialysis patient distribution, by HDF/HD and primary disease, 2015. Abbreviation: PKD, polycystic kidney disease

Table 39

Dialysis patient distribution, by HDF/HD and primary disease, 2015

Primary disease

HDF (%)

HD (%)

Chronic glomerulonephritis

18,937

(35.2)

70,315

(28.3)

Chronic pyelonephritis

533

(1.0)

2272

(0.9)

RPGN

382

(0.7)

2025

(0.8)

PIH

427

(0.8)

1052

(0.4)

Unclassified nephritis

278

(0.5)

1031

(0.4)

PKD

2055

(3.8)

8869

(3.6)

Nephrosclerosis

4159

(7.7)

24,511

(9.9)

Hypertensive emergencies

432

(0.8)

2070

(0.8)

Diabetes

18,332

(34.1)

98,975

(39.8)

Lupus nephritis

457

(0.8)

1702

(0.7)

Amyloidosis

87

(0.2)

358

(0.1)

Gout

181

(0.3)

853

(0.3)

Inborn errors of metabolism

54

(0.1)

201

(0.1)

Tuberculosis

33

(0.1)

153

(0.1)

Urolithiasis

86

(0.2)

471

(0.2)

Neoplasm of kidney and urinary tract

133

(0.2)

763

(0.3)

Urinary tract obstruction

114

(0.2)

589

(0.2)

Myeloma

36

(0.1)

247

(0.1)

Hypoplastic kidney

143

(0.3)

439

(0.2)

Undetermined

5108

(9.5)

23,795

(9.6)

Rejected kidney

526

(1.0)

1559

(0.6)

Others

1275

(2.4)

6462

(2.6)

Subtotal

53,768

(100.0)

248,712

(100.0)

No information available

8

 

13

 

Total

53,776

 

248,725

 

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

Figure 37
Fig. 37

HDF patient distribution, by sex and dialysis vintage, 2015

Table 40

HDF Patient distribution, by sex and dialysis vintage, 2015

Sex

< 5

5 ≤, < 10

10 ≤, < 15

15 ≤, < 20

20 ≤, < 25

25 ≤, < 30

30 ≤, < 35

35 ≤, < 40

40 ≤

Subtotal

Unspecified

No information available

Total

Mean age

S.D.

Male (%)

13,311 (38.8)

9066 (26.4)

5027 (14.7)

2914 (8.5)

1765 (5.1)

1088 (3.2)

623 (1.8)

366 (1.1)

118 (0.3)

34,278 (100.0)

38

 

34,316

8.83

8.24

Female (%)

5877 (30.2)

4705 (24.2)

3100 (16.0)

2149 (11.1)

1509 (7.8)

1015 (5.2)

653 (3.4)

331 (1.7)

96 (0.5)

19,435 (100.0)

25

 

19,460

11.03

9.34

Subtotal (%)

19,188 (35.7)

13,771 (25.6)

8127 (15.1)

5063 (9.4)

3274 (6.1)

2103 (3.9)

1276 (2.4)

697 (1.3)

214 (0.4)

53,713 (100.0)

63

 

53,776

9.63

8.71

No information available (%)

             

0

0

Total (%)

19,188 (35.7)

13,771 (25.6)

8127 (15.1)

5063 (9.4)

3274 (6.1)

2103 (3.9)

1276 (2.4)

697 (1.3)

214 (0.4)

53,713 (100.0)

63

 

53,776

9.63

8.71

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

Types and annual changes of HDF treatment modality

The most numerous HDF patients were online HDF patients at 44,527 persons (82.8% of HDF patients). Most of all HDF patients were for offline HDF before 2011, but the majority became online HDF since 2012 and has significantly increased (Fig. 34, Table 37). In contrast, the number of offline HDF patients has been decreasing year by year. IHDF was added to survey items from 2015 and has been identified as accounting for 6.6% of all HDF. The percentage of HDF therapy, both online and offline, increased as dialysis vintage lengthened, and the percentage of HD showed a decreasing trend (Fig. 38, Table 41). IHDF represented about 1% of all treatment modalities throughout all groups. Other than that, the percentage of PD decreased as dialysis vintage lengthened, whereas hemoadsorption dialysis showed a trend wherein its percentage increased by the same degree that dialysis vintage lengthened.
Figure 38
Fig. 38

Dialysis patient distribution, by dialysis modality and dialysis vintage, 2015. Abbreviations: HDF, hemodiafiltration; AFBF, acetate-free biofiltration; IHDF, intermittent infusion hemodiafiltration

Table 41

Dialysis patient distribution, by dialysis modality and dialysis vintage, 2015

Dialysis modality

< 5

5 ≤, < 10

10 ≤, < 15

15 ≤, < 20

20 ≤, < 25

25 ≤, < 30

30 ≤, < 35

35 ≤, < 40

40 ≤

Subtotal

Unspecified

No information available

Total

Mean

S.D.

Hemodialysis (%)

121,892 (82.4)

62,337 (80.1)

31,462 (78.5)

16,192 (75.1)

8464 (70.4)

4288 (63.7)

2315 (59.1)

1160 (55.3)

314 (50.9)

248,424 (79.4)

300 (76.5)

1 (100.0)

248,725 (79.4)

6.84

7.07

Offline HDF (%)

1329 (0.9)

1254 (1.6)

896 (2.2)

607 (2.8)

435 (3.6)

355 (5.3)

240 (6.1)

157 (7.5)

47 (7.6)

5320 (1.7)

12 (3.1)

 

5332 (1.7)

12.56

10.06

Online HDF (%)

15,968 (10.8)

11,530 (14.8)

6744 (16.8)

4202 (19.5)

2696 (22.4)

1670 (24.8)

990 (25.3)

519 (24.8)

158 (25.6)

44,477 (14.2)

50 (12.8)

 

44,527 (14.2)

9.50

8.55

Push/Pull HDF (%)

37 (0.0)

22 (0.0)

20 (0.0)

11 (0.1)

8 (0.1)

8 (0.1)

2 (0.1)

2 (0.1)

 

110 (0.0)

  

110 (0.0)

10.82

9.09

AFBF (%)

64 (0.0)

73 (0.1)

53 (0.1)

32 (0.1)

18 (0.1)

10 (0.1)

8 (0.2)

5 (0.2)

4 (0.6)

267 (0.1)

  

267 (0.1)

11.61

9.34

IHDF (%)

1790 (1.2)

892 (1.1)

414 (1.0)

211 (1.0)

117 (1.0)

60 (0.9)

36 (0.9)

14 (0.7)

5 (0.8)

3539 (1.1)

1 (0.3)

 

3540 (1.1)

6.66

7.01

Hemofiltration (%)

10 (0.0)

3 (0.0)

1 (0.0)

1 (0.0)

 

1 (0.0)

   

16 (0.0)

  

16 (0.0)

6.06

8.05

Blood adsorption dialysis (%)

8 (0.0)

10 (0.0)

60 (0.1)

142 (0.7)

229 (1.9)

302 (4.5)

312 (8.0)

229 (10.9)

84 (13.6)

1376 (0.4)

  

1376 (0.4)

27.9

8.01

Home hemodialysis (%)

137 (0.1)

160 (0.2)

96 (0.2)

70 (0.3)

38 (0.3)

24 (0.4)

8 (0.2)

8 (0.4)

3 (0.5)

544 (0.2)

11 (2.8)

 

555 (0.2)

10.8

8.32

Peritoneal dialysis (%)

6782 (4.6)

1520 (2.0)

314 (0.8)

87 (0.4)

26 (0.2)

12 (0.2)

6 (0.2)

2 (0.1)

2 (0.3)

8751 (2.8)

18 (4.6)

 

8769 (2.8)

2.99

3.55

Subtotal (%)

148,017 (100.0)

77,801 (100.0)

40,060 (100.0)

21,555 (100.0)

12,031 (100.0)

6730 (100.0)

3917 (100.0)

2096 (100.0)

617 (100.0)

312,824 (100.0)

392 (100.0)

1 (100.0)

313,217 (100.0)

7.31

7.55

No information available

               

Total

148,017

77,801

40,060

21,555

12,031

6730

3917

2096

617

312,824

392

1

313,217

7.31

7.55

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

HDF prescriptions

Regarding the dilution method, most of online HDF involved pre-dilution, whereas offline HDF and AFBF mostly involved post-dilution (Fig. 39, Table 42). HDF dialysis prescriptions were illustrated four ways: by method (online, offline) × by dilution method (pre-dilution, post-dilution). The combination with the largest number of patients was online/pre-dilution with 35,994 persons, and the smallest was offline/pre-dilution with 484 persons. First, comparing the blood flow rate that for online HDF tended to be higher than that for offline HDF, and no clear difference was found between pre- and post-dilution (Fig. 40, Table 43). The blood flow rate for the online HDF/pre-dilution combination was the highest, with a mean of 229 mL/min. Fifty percent of more patients were found to have a blood flow rate of 220 mL/min or higher, whereas 8.8% had a blood flow rate of 300 mL/min or higher. There was no clear difference between the combinations in terms of dialysis time (Fig. 41, Table 44).
Figure 39
Fig. 39

HDF patient distribution, by HDF modality and dilution mode, 2015

Table 42

Patient distribution, by HDF modality and dilution mode, 2015

HDF modality

Pre-dilution

Post-dilution

Pre- and post-dilution

Other dilution mode

Subtotal

Unspecified

No information available

Total

Online HDF (%)

36,778 (94.9)

1657 (4.3)

1 (0.0)

317 (0.8)

38,753 (100.0)

 

5774

44,527

Offline HDF (%)

499 (11.7)

3772 (88.2)

(0.0)

7 (0.2)

4278 (100.0)

1

1053

5332

Push/Pull HDF (%)

6 (7.5)

29 (36.3)

1 (1.3)

44 (55.0)

80 (100.0)

 

30

110

AFBF (%)

4 (2.9)

133 (96.4)

(0.0)

1 (0.7)

138 (100.0)

 

129

267

IHDF (%)

383 (21.0)

67 (3.7)

43 (2.4)

1327 (72.9)

1820 (100.0)

1

1719

3540

Subtotal

37,670

5658

45

1696

45,069

2

8705

53,776

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

Figure 40
Fig. 40

HDF patient distribution, by dilution mode and blood flow rate, 2015

Table 43

HDF patient distribution, by dilution mode and blood flow rate, 2015

Dilution mode

100 ≤, < 120

120 ≤, < 140

140 ≤, < 160

160 ≤, < 180

180 ≤, < 200

200 ≤, < 220

220 ≤, < 240

240 ≤, < 260

260 ≤, < 280

280 ≤, < 300

300 ≤, < 350

350 ≤, < 400

400 ≤

Subtotal

No information available

Total

Mean

S.D.

Online HDF, Pre-dilution

33 (0.1)

60 (0.2)

932 (2.6)

380 (1.1)

2198 (6.1)

11,410 (31.8)

6111 (17.0)

9382 (26.2)

988 (2.8)

1193 (3.3)

2571 (7.2)

400 (1.1)

193 (0.5)

35,851 (100.0)

143

35,994

228.50

40.40

Online HDF, Post-dilution

1 (0.1)

0 (0.0)

66 (4.1)

24 (1.5)

113 (7.0)

514 (31.9)

257 (15.9)

394 (24.4)

44 (2.7)

74 (4.6)

110 (6.8)

10 (0.6)

5 (0.3)

1612 (100.0)

5

1617

225.60

39.80

Offline HDF, pre-dilution

1 (0.2)

7 (1.5)

41 (8.6)

5 (1.0)

53 (11.1)

213 (44.6)

54 (11.3)

80 (16.7)

7 (1.5)

4 (0.8)

12 (2.5)

1 (0.2)

0 (0.0)

478 (100.0)

6

484

207.20

35.00

Offline HDF, post-dilution

9 (0.2)

20 (0.5)

194 (5.3)

77 (2.1)

396 (10.8)

1468 (39.9)

596 (16.2)

603 (16.4)

100 (2.7)

77 (2.1)

124 (3.4)

10 (0.3)

3 (0.1)

3677 (100.0)

24

3701

213.20

35.80

Population: in-center hemodiafiltration (three times a week)

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

Figure 41
Fig. 41

HDF patient distribution, by dilution mode and dialysis time, 2015

Table 44

HDF patient distribution, by dilution mode and dialysis time, 2015

Dilution mode

< 3.0

3.0 ≤, < 3.5

3.5 ≤, < 4.0

4.0 ≤, < 4.5

4.5 ≤, < 5.0

5.0 ≤, < 5.5

5.5 ≤, < 6.0

6.0 ≤

Subtotal

No information available

Total

Mean

S.D.

Online HDF, Pre-dilution

53 (0.1)

2075 (5.8)

2274 (6.3)

24,117 (67.1)

3311 (9.2)

3655 (10.2)

167 (0.5)

285 (0.8)

35,937 (100.0)

57

35,994

4.10

0.50

Online HDF, post-dilution

1 (0.1)

124 (7.7)

103 (6.4)

1044 (64.7)

164 (10.2)

163 (10.1)

6 (0.4)

9 (0.6)

1614 (100.0)

3

1617

4.07

0.50

Offline HDF, pre-dilution

1 (0.2)

40 (8.3)

12 (2.5)

344 (71.2)

40 (8.3)

40 (8.3)

2 (0.4)

4 (0.8)

483 (100.0)

1

484

4.05

0.50

Offline HDF, post-dilution

3 (0.1)

190 (5.1)

194 (5.3)

2507 (67.9)

349 (9.5)

394 (10.7)

15 (0.4)

38 (1.0)

3690 (100.0)

11

3701

4.12

0.49

Population: in-center hemodiafiltration (three times a week)

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

The online HDF/pre-dilution combination had the highest substitution volume, with a mean of 40.1 L (per session), whereas online/post-dilution combination had 10.0 L (Fig. 42, Table 45). Offline HDF had substitution volumes of 10.6 and 8.1 L with pre-dilution and post-dilution, respectively. On about the annual changes in substitution volume, the number of patients with online HDF/pre-dilution tended to increase yearly, although no changes in the substitution volume were observed (Fig. 43, Table 46). Online HDF/post-dilution also did not largely change over time. In contrast, the number of offline HDF/pre-dilution patients decreased in 2015, although the substitution volume showed a slight increasing trend yearly. The number of patients with offline HDF/post-dilution tended to decrease, but the substitution volume slightly increased.
Figure 42
Fig. 42

Mean substitution volume, by online/offline and dilution mode, 2015

Table 45

Mean substitution volume, by online/offline and dilution mode, 2015

  

Pre-dilution

Post-dilution

Pre- and post-dilution

Other dilution mode

Subtotal

Unspecified

No information available

Total

Online HDF

Patients

36,778

1657

1

317

38,753

 

5774

44,527

Mean

40.1

10.0

 

1.8

38.6

 

40.0

38.6

S.D.

15.5

4.8

 

4.0

16.6

  

16.6

Offline HDF

Patients

499

3772

 

7

4278

1

1053

5332

Mean

10.6

8.1

 

10.0

8.4

1.0

 

8.4

S.D.

7.1

2.2

 

13.7

3.4

  

3.4

Figure 43
Fig. 43

Trend of substitutional fluid volume per single session (L), 2012–2015

Table 46

The trend of substitutional fluid volume per single session (L), 2012–2015

Online HDF with pre-dilution

Year

1 L ≤, < 10

10 L ≤, < 20

20 L ≤, < 30

30 L ≤, < 40

40 L ≤, < 50

50 L ≤, < 60

60 L ≤, < 70

70 L ≤, < 80

80 L ≤

Subtotal

No information available

Total

Mean

S.D.

 2012

415 (3.7)

711 (6.4)

1829 (16.4)

2320 (20.8)

3373 (30.2)

913 (8.2)

1102 (9.9)

345 (3.1)

145 (1.3)

11,153 (100.0)

122

11,275

39.1

16.7

 2013

464 (2.4)

936 (4.9)

2728 (14.4)

3730 (19.7)

6791 (35.8)

1558 (8.2)

2009 (10.6)

445 (2.3)

316 (1.7)

18,977 (100.0)

267

19,244

40.6

15.8

 2014

1030 (3.6)

1347 (4.7)

4583 (16.0)

5399 (18.8)

10,512 (36.6)

2138 (7.4)

2693 (9.4)

563 (2.0)

450 (1.6)

28,715 (100.0)

1166

29,881

39.6

15.8

 2015

907 (2.5)

2068 (5.7)

5233 (14.5)

6687 (18.5)

13,727 (38.0)

2514 (7.0)

3660 (10.1)

794 (2.2)

494 (1.4)

36,084 (100.0)

694

36,778

40.1

15.5

Online HDF with post-dilution

Year

1 L ≤, < 5

5 L ≤, < 10

10 L ≤, < 15

15 L ≤, < 20

20 L ≤

Subtotal

No information available

Total

Mean

S.D.

    

 2012

31 (3.4)

289 (31.5)

460 (50.2)

113 (12.3)

24 (2.6)

917 (100.0)

36

953

10.6

3.9

    

 2013

172 (13.0)

536 (40.6)

474 (35.9)

104 (7.9)

35 (2.6)

1321 (100.0)

118

1439

9.2

4.5

    

 2014

89 (6.8)

482 (36.7)

501 (38.2)

104 (7.9)

137 (10.4)

1313 (100.0)

29

1342

10.6

5.0

    

 2015

141 (8.7)

627 (38.8)

619 (38.3)

97 (6.0)

134 (8.3)

1618 (100.0)

39

1657

10.0

4.8

    

Offline HDF with pre-dilution

Year

1 L ≤, < 5

5 L ≤, < 10

10 L ≤, < 15

15 L ≤, < 20

20 L ≤

Subtotal

No information available

Total

Mean

S.D.

    

 2012

20 (4.4)

200 (43.9)

207 (45.4)

7 (1.5)

22 (4.8)

456 (100.0)

29

485

9.2

3.8

    

 2013

40 (7.1)

252 (45.0)

227 (40.5)

5 (0.9)

36 (6.4)

560 (100.0)

20

580

9.4

4.7

    

 2014

89 (14.4)

222 (35.9)

209 (33.8)

15 (2.4)

83 (13.4)

618 (100.0)

20

638

10.2

6.6

    

 2015

59 (12.4)

198 (41.8)

133 (28.1)

9 (1.9)

75 (15.8)

474 (100.0)

25

499

10.6

7.1

    

Offline HDF with post-dilution

Year

1 L ≤,< 5

5 L ≤,< 10

10 L ≤,< 15

15 L ≤,< 20

20 L ≤

Subtotal

No information available

Total

Mean

S.D.

    

 2012

492 (9.9)

2845 (31.5)

1620 (50.2)

16 (12.3)

5 (2.6)

4978 (100.0)

71

5049

7.8

2.3

    

 2013

508 (10.1)

2775 (55.1)

1722 (34.2)

16 (0.3)

13 (0.3)

5034 (100.0)

180

5214

7.9

2.4

    

 2014

338 (8.3)

2235 (54.7)

1492 (36.5)

11 (0.3)

7 (0.2)

4083 (100.0)

192

4275

8.0

2.3

    

 2015

293 (8.1)

1913 (53.1)

1385 (38.4)

7 (0.2)

5 (0.1)

3603 (100.0)

169

3772

8.1

2.2

    

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

Urea kinetics, nutrition, and inflammation in HDF patients

Urea kinetics, nutritional, and inflammation status were compared between HD and HDF patients (by each dilution method). When we compared urea kinetics using single pool Kt/V urea (Kt/Vsp), the Kt/Vsp for online HDF/pre- and post-dilution and offline HDF/post-dilution combinations tended to be higher than that for HD. Offline HDF/pre-dilution Kt/Vsp was largely the same as for HD (Fig. 44, Table 47). Subsequently, we compared normalized protein catabolic rate (nPCR), serum albumin concentration, creatinine concentration, and % creatinine generation rate (%CGR) as an evaluation of nutritional status. No clear difference was found between HDF and HD for nPCR and albumin concentration. Creatinine concentration was higher for online HDF/pre- and post-dilution than with HD, and largely the same as with HD for offline HDF/pre- and post-dilution. %CGR was higher for online HDF/pre- and post-dilution than for HD (Fig. 45, Table 47).
Figure 44
Fig. 44

Kt/Vsp, by dialysis modality and sex, 2015

Table 47

Comparisons of HD, online HDF, and offline HDF, (1), 2015

 

Hemodialysis

OnlineHDF

OfflineHDF

 

Pre-dilution

Post-dilution

Pre-dilution

Post-dilution

Number of patients (%)

223,856

35,994

1617

484

3701

Male

144,442

23,308

998

302

2226

Male (%)

64.5

64.8

61.7

62.4

60.1

Percentage of diabetes (%)

39.9

34.1

32.2

32.0

30.7

Age

68.49 ± 12.29

65.04 ± 12.48

64.85 ± 12.75

65.94 ± 13.03

66.33 ± 12.12

Dialysis vintage (years)

6.96 ± 7.10

9.42 ± 8.47

10.9 ± 9.27

12.61 ± 10.46

12.76 ± 10.00

Dialysis time (minute)

238.7 ± 31.5

245.8 ± 29.8

244.1 ± 29.9

243.3 ± 30.1

247.0 ± 29.5

Blood flow rate (mL/min)

205.8 ± 36.3

228.5 ± 40.4

225.6 ± 39.8

207.2 ± 35.0

213.2 ± 35.8

Kt/Vsp malea

1.41 ± 0.26

1.44 ± 0.26

1.49 ± 0.25

1.40 ± 0.26

1.46 ± 0.26

Kt/Vsp female a

1.64 ± 0.31

1.70 ± 0.31

1.73 ± 0.32

1.61 ± 0.38

1.71 ± 0.32

Serum albumin (male)

3.59 ± 0.44

3.63 ± 0.37

3.59 ± 0.39

3.55 ± 0.46

3.55 ± 0.43

Serum albumin (female)

3.53 ± 0.44

3.57 ± 0.37

3.54 ± 0.38

3.50 ± 0.44

3.49 ± 0.41

Normalized protein catabolic rate (g/kg/day, male)a

0.85 ± 0.17

0.87 ± 0.17

0.88 ± 0.15

0.84 ± 0.17

0.87 ± 0.17

normalized protein catabolic rate (g/kg/day, female)a

0.88 ± 0.19

0.91 ± 0.18

0.90 ± 0.18

0.88 ± 0.16

0.90 ± 0.18

Pre-dialysis serum creatinine (male)a

10.89 ± 2.80

11.48 ± 2.70

11.47 ± 2.71

11.03 ± 2.83

11.03 ± 2.76

Pre-dialysis serum creatinine (female)a

9.04 ± 2.34

9.60 ± 2.19

9.43 ± 2.25

9.23 ± 2.14

9.18 ± 2.06

Percent creatinine generation rate (male)a

98.61 ± 25.77

102.22 ± 23.75

103.00 ± 22.89

96.59 ± 26.78

99.37 ± 24.18

Percent creatinine generation rate (female)a

97.82 ± 26.59

102.61 ± 23.93

101.85 ± 24.88

96.58 ± 23.79

99.26 ± 23.95

Population: in-center hemodialysis or hemodiafiltration (three times a week)

aKt/V, nPCR, creatinine concentration, and %CGR were summarized in the patients with vintages of 2 years or more and receiving dialysis three times a week

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

For the indices from age to percent creatinine generation rate (female), “mean ± S.D.” are shown

Figure 45
Fig. 45

Comparisons, by dialysis modality and sex, 2015

We compared serum CRP concentration as an inflammation index (Fig. 45, Table 48). Compared with HD, the concentration tended to be low with online HDF/pre-dilution, and showed a high trend with offline HDF/pre- and post-dilution.
Table 48

Comparisons of HD, online HDF, and offline HDF, (2), 2015

 

Hemodialysis

Online HDF

Offline HDF

 

Pre-dilution

Post-dilution

Pre-dilution

Post-dilution

Serum CRP level (mg/dL)

0.63 ± 1.84

0.52 ± 1.57

0.61 ± 1.87

0.80 ± 1.76

0.72 ± 1.74

Pre-dialysis serum calcium (mg/dL)

9.18 ± 0.75

9.18 ± 0.73

9.28 ± 0.71

9.27 ± 0.80

9.29 ± 0.80

Pre-dialysis serum phosphorus (mg/dL)

5.23 ± 1.44

5.42 ± 1.42

5.41 ± 1.42

5.33 ± 1.60

5.29 ± 1.49

Intact PTH level (pg/ml)

177.1 ± 169.0

184.5 ± 177.5

197.7 ± 197.6

175.2 ± 171.4

174.7 ± 179.9

Pre-dialysis serum total cholesterol (mg/dl)

155.0 ± 35.5

159.5 ± 35.5

163.51 ± 37.5

153.5 ± 31.7

156.5 ± 36.7

Pre-dialysis hemoglobin (g/dL)

10.73 ± 1.28

10.92 ± 1.24

10.84 ± 1.19

10.73 ± 1.38

10.75 ± 1.31

Population: in-center hemodialysis or hemodiafiltration (three times a week)

Management for anemia and CKD-MBD in HDF patients

We evaluated the management for anemia and CKD-MBD markers in HDF patients compared with HD patients. Hemoglobin concentration showed a slightly high trend with online HDF/pre- and post-dilution. Phosphorus concentration and intact PTH levels for online HDF/pre- and post-dilution were somewhat high compared to HD. Corrected calcium concentration was slightly high with online HDF/post-dilution and offline HDF/pre- and post-dilution (Fig. 45, Table 48).

Chapter 4: Current status of peritoneal dialysis (PD)

PD patient dynamics

There were 9322 PD patients at the end of 2015. The variations of PD therapy were PD only, an combination with HD once weekly, twice weekly, thrice weekly, and some other combinations; and the number of patients in each modality was 7460 persons, 1576 persons, 185 persons, 30 persons, and 71 persons, respectively (Table 49). The total number of PD patients had been gradually decreasing since 2009 (Fig. 46). However, we should understand that a total number of PD patients in JRDR did not always reflect the real number of PD patients in Japan. The JRDR survey only targeted facilities performing HD; hence, PD patients treated at other facilities are not included. We started a survey of the number of incident PD patients since 2015, and have found 2197 patients.
Table 49

Prevalent PD patient counts, by the combination of HD, 2015

Number of peritoneal dialysis patients

PD only

7460

PD + HD 1/week

1576

PD + HD 2/week

185

PD + HD 3/week

30

PD + HD other frequencies

71

Prevalent peritoneal dialysis patients

9322

Incident peritoneal dialysis patients

2197

The above data were obtained from the patient survey

Figure 46
Fig. 46

Prevalent and incident PD patient counts, 2009–2015

A total of 8846 PD patients responded to patient questionnaires, including 5728 (64.8%) males and 3118 (35.2%) females, with mean ages of 62.8 years and 62.7 years for males and females, respectively. The age distribution showed a normal distribution, peaking with the 65- to 74-year age category, which was the same trend with HD patients (Fig. 3) (Fig. 47, Table 50). The PD vintage distribution showed that less than 2 years accounted for 43.9% of the total and 8.4% were 8 years or longer (Fig. 48, Table 51). Diabetic nephropathy was the primary disease in 31.9% of PD patients, which was very close to the 32.4% for chronic glomerulonephritis. Comparing HD patients, the percentage of diabetic nephropathy showed a lower prevalence (Fig. 49, Table 52).
Figure 47
Fig. 47

Prevalent PD patient distribution, by age and sex, 2015

Table 50

Prevalent PD patient distribution, by age and sex, 2015

Age

Male

Female

Subtotal

No information available

Total

< 15 (%)

45 (0.8)

44 (1.4)

89 (1.0)

 

89 (1.0)

15 ≤, < 30 (%)

59 (1.0)

43 (1.4)

102 (1.2)

 

102 (1.2)

30 ≤, < 45 (%)

420 (7.3)

248 (8.0)

668 (7.6)

 

668 (7.6)

45 ≤, < 60 (%)

1522 (26.6)

822 (26.4)

2344 (26.5)

 

2344 (26.5)

60 ≤, < 75 (%)

2601 (45.4)

1259 (40.4)

3860 (43.6)

 

3860 (43.6)

75 ≤, < 90 (%)

1019 (17.8)

636 (20.4)

1655 (18.7)

 

1655 (18.7)

90 ≤ (%)

62 (1.1)

66 (2.1)

128 (1.4)

 

128 (1.4)

Subtotal (%)

5728 (100.0)

3118 (100.0)

8846 (100.0)

 

8846 (100.0)

No information available

     

 Total

5728

3118

8846

 

8846

 Mean

62.8

62.74

62.78

0

62.78

 S.D.

13.87

15.77

14.57

0

14.57

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

Figure 48
Fig. 48

Prevalent PD patient distribution, by PD vintage and sex, 2015

Table 51

Prevalent PD patient distribution, by PD vintage and sex, 2015

PD vintage

Male

Female

Subtotal

No information available

Total

< 1 (%)

921 (24.9)

446 (21.3)

1367 (23.6)

 

1367 (23.6)

1 ≤, < 2 (%)

790 (21.4)

385 (18.4)

1175 (20.3)

 

1175 (20.3)

2 ≤, < 4 (%)

1000 (27.1)

529 (25.3)

1529 (26.4)

 

1529 (26.4)

4 ≤, < 6 (%)

499 (13.5)

332 (15.9)

831 (14.4)

 

831 (14.4)

6 ≤, < 8 (%)

207 (5.6)

190 (9.1)

397 (6.9)

 

397 (6.9)

8 ≤, < 10 (%)

125 (3.4)

90 (4.3)

215 (3.7)

 

215 (3.7)

10 ≤ (%)

151 (4.1)

121 (5.8)

272 (4.7)

 

272 (4.7)

Subtotal (%)

3693 (100.0)

2093 (100.0)

5786 (100.0)

 

5786 (100.0)

No information available

2035

1025

3060

 

3060

Total

5728

3118

8846

 

8846

Mean

3.07

3.63

3.27

 

3.27

S.D.

3.09

3.43

3.23

 

3.23

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

Figure 49
Fig. 49

Prevalent dialysis patient distribution, by PD or HD and primary disease, 2015. Abbreviation: PKD, polycystic kidney disease

Table 52

Prevalent patient distribution, by PD or HD and primary disease, 2015

Primary disease

Peritoneal dialysis (%)

Hemodialysis (%)

Diabetes

2823 (31.9)

98,975 (39.8)

Chronic glomerulonephritis

2864 (32.4)

70,315 (28.3)

Nephrosclerosis

1103 (12.5)

24,511 (9.9)

PKD

264 (3.0)

8869 (3.6)

Chronic pyelonephritis

98 (1.1)

2272 (0.9)

Others

1694 (19.1)

43,783 (17.6)

Subtotal

8846 (100.0)

248,712 (100.0)

No information available

 

13

Total

8846

248,725

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

Present status of PD + HD combined therapy

The percentage of the patients undergoing PD only was 80.3% of the total, the percentages of PD only and PD + HD combined therapy both revealed no changes over time (Fig. 50, Table 53). The percentage of the patients undergoing a combination of PD and HD were increased as PD history got longer (Fig. 51, Table 54). The highest frequency of HD combinations was once weekly, and when PD history reached 8 years or longer, 50% or more of PD patients had a combination with HD.
Figure 50
Fig. 50

Prevalent PD patient distribution, by PD + HDF combination frequency, 2009–2015

Table 53

Prevalent patient distribution, by PD + HD combination frequency, 2009–2015

PD + HD combination frequency

2009

2010

2011

2012

2013

2014

2015

PD only (%)

6022 (79.3)

7436 (80.6)

7370 (80.7)

7323 (80.4)

7324 (80.3)

7188 (79.7)

7104 (80.3)

PD + HD 1/week (%)

1197 (15.8)

1388 (15.0)

1393 (15.2)

1428 (15.7)

1503 (16.5)

1544 (17.1)

1470 (16.6)

PD + HD 2/week (%)

191 (2.5)

225 (2.4)

224 (2.5)

219 (2.4)

173 (1.9)

177 (2.0)

172 (1.9)

PD + HD 3/week (%)

53 (0.7)

51 (0.6)

46 (0.5)

55 (0.6)

34 (0.4)

40 (0.4)

29 (0.3)

PD + HD other frequencies (%)

128 (1.7)

130 (1.4)

105 (1.1)

86 (0.9)

87 (1.0)

73 (0.8)

71 (0.8)

Subtotal (%)

7591 (100.0)

9230 (100.0)

9138 (100.0)

9111 (100.0)

9121 (100.0)

9022 (100.0)

8846 (100.0)

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

Figure 51
Fig. 51

Prevalent PD patient distribution, by PD vintage and PD + HD combination frequency, 2015

Table 54

Prevalent patient distribution, by PD vintage and PD + HD combination frequency, 2015

PD + HD combination frequency

< 1

1 ≤, < 2

2 ≤, < 4

4 ≤, < 6

6 ≤, < 8

8 ≤, < 10

10 ≤

Subtotal

No information available

Total

Mean

S.D.

PD only (%)

1326 (28.1)

1067 (22.6)

1269 (26.9)

605 (12.8)

236 (5.0)

101 (2.1)

108 (2.3)

4712 (100.0)

2392

7104

2.67

2.65

PD + HD 1/week (%)

37 (4.1)

90 (10.1)

228 (25.5)

186 (20.8)

142 (15.9)

91 (10.2)

120 (13.4)

894 (100.0)

576

1470

5.72

3.95

PD + HD 2/week (%)

4 (3.4)

9 (7.8)

18 (15.5)

25 (21.6)

12 (10.3)

21 (18.1)

27 (23.3)

116 (100.0)

56

172

6.95

4.44

PD + HD 3/week (%)

(0.0)

2 (14.3)

6 (42.9)

1 (7.1)

(0.0)

(0.0)

5 (35.7)

14 (100.0)

15

29

7.44

7.28

PD + HD other frequencies (%)

(0.0)

7 (14.0)

8 (16.0)

14 (28.0)

7 (14.0)

2 (4.0)

12 (24.0)

50 (100.0)

21

71

6.65

4.86

Subtotal (%)

1367 (23.6)

1175 (20.3)

1529 (26.4)

831 (14.4)

397 (6.9)

215 (3.7)

272 (4.7)

5786 (100.0)

3060

8846

3.27

3.23

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

PD prescriptions

The mean volume of PD fluid per day was 6.71 and 5.98 L for males and females, respectively. The volume was found to decrease as age increased (Fig. 52, Table 55) and increased as PD vintage got longer (Fig. 53, Table 56). When we examined the PD treatment times, there was hardly any difference between sexes with 17.8 and 17.6 h for males and females, respectively, and no clear difference was found by age (Fig. 54, Table 57). In contrast, a trend was found in which PD treatment time became longer as PD vintage got longer. In particular, PD patients receiving 24-h treatment made up 76.3% of the total when PD vintage was 8 years or longer (Fig. 55, Table 58). The percentage of the patients using the automated peritoneal dialysis (APD) was 44.9% of all patients undergoing PD alone (Table 59). As for replacement of PD dialysis fluid, most used bag replacement machines utilizing ultraviolet light (52.4%), followed by those using completely manual methods (30.2%), and those using thermal sterile connecting devices (14.8%) (Table 60).
Figure 52
Fig. 52

PD fluid volume, by age and sex, 2015

Table 55

PD dialysis fluid volume, by age and sex, 2015

  

< 45

45 ≤, < 60

60 ≤, < 75

75 ≤

Subtotal

Male

Mean

7.56

7.26

6.76

5.65

6.71

S.D.

3.79

2.38

2.33

2.12

2.54

Female

Female

6.80

6.47

6.05

5.01

5.98

Mean

3.44

2.38

2.11

1.99

2.39

Figure 53
Fig. 53

Prevalent PD patient distribution, by PD vintage and PD fluid volume, 2015

Table 56

Prevalent patient distribution, by PD vintage and PD fluid volume, 2015

PD fluid volume

< 1

1 ≤, < 2

2 ≤, < 4

4 ≤, < 6

6 ≤, < 8

8 ≤

Subtotal

No information available

Total

Mean

S.D.

< 2 (%)

63 (50.4)

30 (24.0)

17 (13.6)

10 (8.0)

2 (1.6)

3 (2.4)

125 (100.0)

3

128

1.31

2.09

2 ≤, < 4 (%)

141 (40.5)

84 (24.1)

79 (22.7)

32 (9.2)

5 (1.4)

7 (2.0)

348 (100.0)

7

355

1.46

1.97

4 ≤, < 6 (%)

361 (36.6)

225 (22.8)

240 (24.3)

107 (10.8)

28 (2.8)

26 (2.6)

987 (100.0)

10

997

1.71

2.06

6 ≤, < 8 (%)

419 (25.6)

380 (23.2)

477 (29.2)

211 (12.9)

89 (5.4)

59 (3.6)

1635 (100.0)

39

1674

2.27

2.63

8 ≤, < 10 (%)

180 (18.2)

224 (22.7)

289 (29.3)

147 (14.9)

73 (7.4)

75 (7.6)

988 (100.0)

52

1040

2.89

3

10 ≤, < 12 (%)

29 (11.6)

49 (19.7)

92 (36.9)

45 (18.1)

15 (6.0)

19 (7.6)

249 (100.0)

8

257

3.2

3.14

12 ≤ (%)

13 (12.0)

18 (16.7)

28 (25.9)

30 (27.8)

10 (9.3)

9 (8.3)

108 (100.0)

2

110

3.6

3.35

Subtotal (%)

1206 (27.2)

1010 (22.7)

1222 (27.5)

582 (13.1)

222 (5.0)

198 (4.5)

4440 (100.0)

121

4561

2.28

2.66

No information available (%)

120 (44.1)

57 (21.0)

47 (17.3)

23 (8.5)

14 (5.1)

11 (4.0)

272 (100.0)

2271

2543

1.75

2.59

Total (%)

1326 (28.1)

1067 (22.6)

1269 (26.9)

605 (12.8)

236 (5.0)

209 (4.4)

4712 (100.0)

2392

7104

2.25

2.66

Mean

5.62

6.33

6.7

6.94

7.36

7.36

6.42

7.17

6.44

  

S.D.

2.33

2.45

2.48

2.68

2.25

2.47

2.51

2.14

2.51

  

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

Figure 54
Fig. 54

PD treatment time, by age and sex, 2015

Table 57

PD treatment time, by age and sex, 2015

  

< 45

45 ≤, < 60

60 ≤, < 75

75 ≤

Subtotal

Male

Mean

16.45

17.97

18.03

17.71

17.81

S.D.

7.55

7.47

7.38

7.59

7.47

Female

Female

16.56

17.9

18.27

16.34

17.55

Mean

7.35

7.56

7.24

7.51

7.44

Figure 55
Fig. 55

Prevalent PD patient distribution, by PD vintage and PD treatment time, 2015

Table 58

Prevalent patient distribution, by PD vintage and PD treatment time, 2015

Treatment time

< 1

1 ≤, < 2

2 ≤, < 4

4 ≤, < 6

6 ≤, < 8

8 ≤

Subtotal

No information available

Total

Mean

S.D.

< 4 (%)

38 (31.9)

19 (16.0)

38 (31.9)

16 (13.4)

2 (1.7)

6 (5.0)

119 (100.0)

 

119

2.14

2.37

4 ≤, < 8 (%)

91 (43.3)

42 (20.0)

45 (21.4)

18 (8.6)

5 (2.4)

9 (4.3)

210 (100.0)

1

211

1.7

2.6

8 ≤, < 12 (%)

352 (35.9)

238 (24.3)

261 (26.6)

83 (8.5)

30 (3.1)

17 (1.7)

981 (100.0)

15

996

1.66

2.11

12 ≤, < 16 (%)

127 (32.7)

90 (23.2)

104 (26.8)

46 (11.9)

13 (3.4)

8 (2.1)

388 (100.0)

3

391

1.86

2.28

16 ≤, < 20 (%)

60 (25.6)

67 (28.6)

58 (24.8)

35 (15.0)

10 (4.3)

4 (1.7)

234 (100.0)

4

238

2.03

2.32

20 ≤, < 24 (%)

13 (19.1)

17 (25.0)

25 (36.8)

8 (11.8)

4 (5.9)

1 (1.5)

68 (100.0)

1

69

2.19

1.91

24 ≤ (%)

500 (21.5)

509 (21.9)

670 (28.8)

351 (15.1)

149 (6.4)

145 (6.2)

2324 (100.0)

78

2402

2.67

2.89

Subtotal (%)

1181 (27.3)

982 (22.7)

1201 (27.8)

557 (12.9)

213 (4.9)

190 (4.4)

4324 (100.0)

102

4426

2.26

2.65

No information available (%)

145 (37.4)

85 (21.9)

68 (17.5)

48 (12.4)

23 (5.9)

19 (4.9)

388 (100.0)

2290

2678

2.09

2.75

Total (%)

1326 (28.1)

1067 (22.6)

1269 (26.9)

605 (12.8)

236 (5.0)

209 (4.4)

4712 (100.0)

2392

7104

2.25

2.66

Mean

15.77

17.55

17.96

19.11

20.26

20.41

17.64

20.91

17.71

  

S.D.

7.67

7.33

7.43

7.02

6.31

6.87

7.47

5.98

7.46

  

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

Table 59

Prevalent PD patient counts, by APD machine use, 2015

 

Patients on APD

Patients on CAPD

Subtotal

Unspecified

No information available

Total

Patients (%)

2061 (44.9)

2527 (55.1)

4588 (100.0)

9

2507

7104

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

Table 60

Prevalent PD patient counts, by PD fluid changing maneuver, 2015

 

Manual exchange

Devices using UV irradiation

Devices using heat sterilization

Other devices including semi-automated

Subtotal

Unspecified

No information available

Total

Patients (%)

1372 (30.2)

2382 (52.4)

672 (14.8)

122 (2.7)

4548 (100.0)

16

2540

7104

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

Residual kidney function (urine volume and residual kidney Kt/V)

We evaluated the residual kidney function in patients undergoing PD alone by urine volume and residual kidney Kt/V. The mean urine volume per day was 774 and 643 mL for men and women, respectively; thus, a higher tendency was found among males (Fig. 56, Table 61). The difference was unclear for age, but as PD vintage got longer, urine volume showed a decreasing trend. When PD vintage was 8 years or longer, 55.2% had a urine volume < 100 mL (Fig. 57, Table 62). The mean residual kidney Kt/V was 0.68 and 0.64 for males and females, respectively (Fig. 58, Table 63). The difference was unclear for age, but the residual kidney Kt/V also showed a decreasing trend as PD vintage got longer similar to urine volume. Particularly, we found 89.4% to have a residual kidney Kt/V < 0.4 if PD vintage was 8 years or longer (Fig. 59, Table 64).
Figure 56
Fig. 56

Urine volume, by age and sex, 2015

Table 61

Urine volume, by age and sex, 2015

  

< 45

45 ≤, < 60

60 ≤, < 75

75 ≤

Total

Male

Mean

750.74

817.98

776.99

722.85

773.86

S.D.

717.72

609.21

567.5

521.34

583.4

Female

Female

554.39

648.37

674.59

620.58

643.14

Mean

560.01

513.82

552.94

448.63

523.27

Figure 57
Fig. 57

Prevalent PD patient distribution, by PD vintage and urine volume, 2015

Table 62

Prevalent PD patient distribution, by PD vintage and urine volume, 2015

urine volume

< 1

1 ≤, < 2

2 ≤, < 4

4 ≤, < 6

6 ≤, < 8

8 ≤

Subtotal

No information available

Total

Mean

S.D.

< 100 (%)

34 (7.2)

62 (13.2)

117 (24.9)

110 (23.4)

62 (13.2)

85 (18.1)

470 (100.0)

25

495

4.72

3.93

100 ≤, < 400 (%)

93 (14.2)

132 (20.2)

232 (35.5)

124 (19.0)

49 (7.5)

24 (3.7)

654 (100.0)

18

672

2.74

2.23

400 ≤, < 800 (%)

252 (25.5)

259 (26.2)

296 (30.0)

120 (12.2)

38 (3.9)

22 (2.2)

987 (100.0)

31

1018

2.01

2.2

800 ≤, < 1200 (%)

337 (36.6)

221 (24.0)

241 (26.2)

82 (8.9)

23 (2.5)

16 (1.7)

920 (100.0)

18

938

1.59

2.01

1200 ≤, < 1600 (%)

166 (38.2)

111 (25.5)

104 (23.9)

40 (9.2)

12 (2.8)

2 (0.5)

435 (100.0)

9

444

1.47

1.8

1600 ≤ (%)

123 (42.4)

74 (25.5)

57 (19.7)

24 (8.3)

7 (2.4)

5 (1.7)

290 (100.0)

6

296

1.38

1.89

Subtotal (%)

1005 (26.8)

859 (22.9)

1047 (27.9)

500 (13.3)

191 (5.1)

154 (4.1)

3756 (100.0)

107

3863

2.26

2.6

No information available (%)

321 (33.6)

208 (21.8)

222 (23.2)

105 (11.0)

45 (4.7)

55 (5.8)

956 (100.0)

2285

3241

2.19

2.88

Total (%)

1326 (28.1)

1067 (22.6)

1269 (26.9)

605 (12.8)

236 (5.0)

209 (4.4)

4712 (100.0)

2392

7104

2.25

2.66

Mean

950.45

797.06

669.32

545.45

432.99

294.81

729.89

565.37

725.34

  

S.D.

547.26

555

533.21

527.8

490.75

461.98

565.16

549.19

565.3

  

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

Figure 58
Fig. 58

Residual renal Kt/V, by age and sex, 2015

Table 63

Residual renal Kt/V, by age and sex, 2015

  

< 45

45 ≤, < 60

60 ≤, < 75

75 ≤

Subtotal

Male

Mean

0.69

0.61

0.69

0.75

0.68

S.D.

0.72

0.54

0.57

0.6

0.58

Female

Female

0.61

0.64

0.64

0.65

0.64

Mean

0.71

0.66

0.67

0.51

0.64

Figure 59
Fig. 59

Prevalent PD patient distribution, PD vintage and residual renal Kt/V, 2015

Table 64

Patient distribution, PD vintage and residual renal Kt/V, 2015

Residual renal Kt/V

< 1

1 ≤, < 2

2 ≤, < 4

4 ≤, < 6

6 ≤, < 8

8 ≤

Subtotal

No information available

Total

Mean

S.D.

< 0.4 (%)

64 (10.6)

121 (20.1)

196 (32.5)

121 (20.1)

59 (9.8)

42 (7.0)

603 (100.0)

31

634

3.25

2.8

0.4 ≤, < 0.8 (%)

108 (24.1)

126 (28.1)

156 (34.7)

43 (9.6)

12 (2.7)

4 (0.9)

449 (100.0)

15

464

1.8

1.74

0.8 ≤, < 1.2 (%)

108 (33.4)

86 (26.6)

94 (29.1)

29 (9.0)

6 (1.9)

 

323 (100.0)

5

328

1.48

1.54

1.2 ≤, < 1.6 (%)

51 (32.7)

56 (35.9)

33 (21.2)

14 (9.0)

2 (1.3)

 

156 (100.0)

2

158

1.33

1.46

1.6 ≤, < 2.0 (%)

31 (35.2)

19 (21.6)

24 (27.3)

10 (11.4)

4 (4.5)

 

88 (100.0)

5

93

1.64

1.78

2.0 ≤ (%)

21 (35.6)

12 (20.3)

15 (25.4)

7 (11.9)

3 (5.1)

1 (1.7)

59 (100.0)

1

60

1.88

2.31

Subtotal (%)

383 (22.8)

420 (25.0)

518 (30.9)

224 (13.3)

86 (5.1)

47 (2.8)

1678 (100.0)

59

1737

2.21

2.29

No information available (%)

943 (31.1)

647 (21.3)

751 (24.8)

381 (12.6)

150 (4.9)

162 (5.3)

3034 (100.0)

2333

5367

2.27

2.84

Total (%)

1326 (28.1)

1067 (22.6)

1269 (26.9)

605 (12.8)

236 (5.0)

209 (4.4)

4712 (100.0)

2392

7104

2.25

2.66

Mean

0.89

0.72

0.61

0.53

0.38

0.12

0.67

0.51

0.66

  

S.D.

0.58

0.57

0.59

0.63

0.6

0.34

0.61

0.59

0.61

  

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

Peritoneal function (ultrafiltration volume and PD Kt/V)

We evaluated peritoneal function in patients undergoing PD alone by fluid removal volume and PD Kt/V. Mean ultrafiltration volume was 641 and 628 mL for males and females, respectively (Fig. 60, Table 65). The difference was unclear for age, but ultrafiltration volume showed an increasing trend as PD vintage got longer (Fig. 61, Table 66). In patients with a PD vintage of 8 years or longer, 55.6% had an ultrafiltration volume of 800 mL or more. The mean PD Kt/V was 1.20 and 1.37 for males and females, respectively; thus, we found a high trend in females (Fig. 62, Table 67). In terms of age, the < 45 years category was somewhat higher than other age categories. PD Kt/V also showed an increasing trend as PD vintage got longer. We found that 61.1% had a PD Kt/V of 1.6 or more if PD vintage was 8 years or longer (Fig. 63, Table 68).
Figure 60
Fig. 60

Ultrafiltration volume, by age and sex, 2015

Table 65

Ultrafiltration volume, by age and sex, 2015

  

< 45

45 ≤, < 60

60 ≤, < 75

75 ≤

Subtotal

Male

Mean

650.2

715.6

647.0

542.6

641.3

S.D.

528.1

567.1

531.4

463.1

529.1

Female

Mean

601.3

653.7

653.2

570.3

628.4

S.D.

426.1

477.5

485.3

511.2

485.0

Figure 61
Fig. 61

Prevalent PD patient distribution, by PD vintage and ultrafiltration volume, 2015

Table 66

Prevalent PD patient distribution, by PD vintage and ultrafiltration volume, 2015

Ultrafiltration volume

< 1

1 ≤, < 2

2 ≤, < 4

4 ≤, < 6

6 ≤, < 8

8 ≤

Subtotal

No information available

Total

Mean

S.D.

< 0 (%)

106 (46.3)

53 (23.1)

50 (21.8)

16 (7.0)

2 (0.9)

2 (0.9)

229 (100.0)

3

232

1.21

1.66

0 ≤, < 100 (%)

57 (36.1)

34 (21.5)

40 (25.3)

16 (10.1)

7 (4.4)

4 (2.5)

158 (100.0)

1

159

1.77

2.11

100 ≤, < 400 (%)

332 (38.1)

207 (23.8)

206 (23.7)

80 (9.2)

27 (3.1)

19 (2.2)

871 (100.0)

11

882

1.66

2.31

400 ≤, < 800 (%)

403 (30.3)

310 (23.3)

354 (26.6)

149 (11.2)

64 (4.8)

51 (3.8)

1331 (100.0)

28

1359

2.06

2.44

800 ≤, < 1200 (%)

159 (17.0)

191 (20.4)

305 (32.6)

159 (17.0)

69 (7.4)

54 (5.8)

937 (100.0)

34

971

2.90

2.98

1200 ≤, < 1600 (%)

45 (12.0)

83 (22.1)

105 (28.0)

81 (21.6)

34 (9.1)

27 (7.2)

375 (100.0)

27

402

3.19

2.87

1600 ≤ (%)

11 (7.7)

37 (25.9)

50 (35.0)

21 (14.7)

10 (7.0)

14 (9.8)

143 (100.0)

6

149

3.26

3.00

Subtotal (%)

1113 (27.5)

915 (22.6)

1110 (27.4)

522 (12.9)

213 (5.3)

171 (4.2)

4044 (100.0)

110

4154

2.26

2.63

No information available (%)

213 (31.9)

152 (22.8)

159 (23.8)

83 (12.4)

23 (3.4)

38 (5.7)

668 (100.0)

2282

2950

2.19

2.80

Total (%)

1326 (28.1)

1067 (22.6)

1269 (26.9)

605 (12.8)

236 (5.0)

209 (4.4)

4712 (100.0)

2392

7104

2.25

2.66

Mean

444.58

625.77

688.97

757.49

816.45

857.65

630.1

868.98

636.43

  

S.D.

465.93

519.69

514.59

486.67

475.62

494.84

512.47

477.55

512.96

  

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

Figure 62
Fig. 62

PD Kt/V, by age and sex, 2015

Table 67

PD Kt/V, by age and sex, 2015

 

< 45

45 ≤, < 60

60 ≤, < 75

75 ≤

Subtotal

Male

Mean

1.43

1.13

1.21

1.17

1.2

S.D.

0.83

0.57

0.56

0.53

0.59

Female

Mean

1.55

1.32

1.41

1.21

1.37

S.D.

0.85

0.67

0.64

0.64

0.68

Figure 63
Fig. 63

Prevalent PD patient distribution, by PD vintage and PD Kt/V, 2015

Table 68

Prevalent PD patient distribution, by PD vintage and PD Kt/V, 2015

PD Kt/V

< 1

1 ≤, < 2

2 ≤, < 4

4 ≤, < 6

6 ≤, < 8

8 ≤

Subtotal

No information available

Total

Mean

S.D.

< 0.4 (%)

41 (23.6)

45 (25.9)

53 (30.5)

17 (9.8)

15 (8.6)

3 (1.7)

174 (100.0)

1

175

2.16

2.13

0.4 ≤, < 0.8 (%)

66 (33.0)

57 (28.5)

41 (20.5)

19 (9.5)

9 (4.5)

8 (4.0)

200 (100.0)

1

201

1.86

2.33

0.8 ≤, < 1.2 (%)

136 (29.6)

127 (27.6)

137 (29.8)

48 (10.4)

10 (2.2)

2 (0.4)

460 (100.0)

10

470

1.63

1.63

1.2 ≤, < 1.6 (%)

92 (17.8)

134 (25.9)

186 (36.0)

69 (13.3)

21 (4.1)

15 (2.9)

517 (100.0)

19

536

2.28

2.18

1.6 ≤, < 2.0 (%)

53 (14.6)

73 (20.1)

106 (29.1)

70 (19.2)

35 (9.6)

27 (7.4)

364 (100.0)

25

389

3.23

3.19

2.0 ≤ (%)

41 (20.2)

34 (16.7)

61 (30.0)

34 (16.7)

16 (7.9)

17 (8.4)

203 (100.0)

4

207

2.97

2.94

Subtotal (%)

429 (22.4)

470 (24.5)

584 (30.4)

257 (13.4)

106 (5.5)

72 (3.8)

1918 (100.0)

60

1978

2.32

2.46

No information available (%)

897 (32.1)

597 (21.4)

685 (24.5)

348 (12.5)

130 (4.7)

137 (4.9)

2794 (100.0)

2332

5126

2.20

2.78

Total (%)

1326 (28.1)

1067 (22.6)

1269 (26.9)

605 (12.8)

236 (5.0)

209 (4.4)

4712 (100.0)

2392

7104

2.25

2.66

Mean

1.16

1.17

1.29

1.38

1.37

1.56

1.26

1.5

1.26

  

S.D.

0.67

0.56

0.64

0.6

0.72

0.6

0.64

0.38

0.63

  

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

PET and D/P Cr ratio

The testing rate for peritoneal equilibration test (PET) in patients undergoing PD alone was 45.3% and that for Fast PET only was 20.1%, and the untested rate was 34.6% (Table 69). The mean (dialysate/plasma creatinine) D/P Cr ratio was 0.68 and 0.64 for males and females, respectively, and thus was slightly high among males (Fig. 64, Table 70). D/P Cr ratio showed an increasing trend as age increased. Almost no consistent trend was seen in D/P Cr ratio by PD vintage, but the ratio was 0.64 if PD vintage was 6 years or longer, and the ratio decreased slightly to 0.62 if it was 8 years or longer (Fig. 65, Table 71). Concerning the D/P Cr ratio by primary disease, it was highest at 0.70 with diabetic nephropathy, followed by 0.68 with nephrosclerosis (Fig. 66, Table 72).
Table 69

History of PET, 2015

 

Not performed

Standard PET

Fast PET

Subtotal

Unspecified

No information available

Total

Patients

1542

2020

894

4456

99

2549

7104

Figure 64
Fig. 64

D/P Cr ratio, by age and sex, 2015. Abbreviation: D/P Cr ratio, dialysate/plasma creatinine ratio

Table 70

D/P Cr ratio, by age and sex, 2015

  

< 45

45 ≤, < 60

60 ≤, < 75

75 ≤

Subtotal

Male

Mean

0.64

0.67

0.69

0.69

0.68

S.D.

0.13

0.12

0.12

0.13

0.12

Female

Mean

0.62

0.62

0.64

0.69

0.64

S.D.

0.17

0.14

0.13

0.14

0.14

Figure 65
Fig. 65

Prevalent PD patient distribution, by PD vintage and D/P Cr ratio, 2015. Abbreviation: D/P Cr ratio, dialysate/plasma creatinine ratio

Table 71

Patient distribution, by PD vintage and D/P Cr ratio, 2015

D/P Cr ratio

< 1

1 ≤, < 2

2 ≤, < 4

4 ≤, < 6

6 ≤, < 8

8 ≤

Subtotal

No information available

Total

Mean

S.D.

< 0.5 (%)

52 (23.6)

48 (21.8)

60 (27.3)

33 (15.0)

13 (5.9)

14 (6.4)

220 (100.0)

1

221

2.60

2.89

0.5 ≤, < 0.65 (%)

167 (20.2)

173 (20.9)

261 (31.6)

128 (15.5)

56 (6.8)

42 (5.1)

827 (100.0)

26

853

2.63

2.69

0.65 ≤, < 0.81 (%)

173 (16.8)

270 (26.2)

354 (34.4)

136 (13.2)

59 (5.7)

37 (3.6)

1029 (100.0)

39

1068

2.46

2.56

0.81 ≤ (%)

75 (22.3)

101 (30.0)

106 (31.5)

36 (10.7)

12 (3.6)

7 (2.1)

337 (100.0)

7

344

1.99

2.17

Subtotal (%)

467 (19.4)

592 (24.5)

781 (32.4)

333 (13.8)

140 (5.8)

100 (4.1)

2413 (100.0)

73

2486

2.46

2.59

No information available (%)

859 (37.4)

475 (20.7)

488 (21.2)

272 (11.8)

96 (4.2)

109 (4.7)

2299 (100.0)

2319

4618

2.02

2.71

Total (%)

1326 (28.1)

1067 (22.6)

1269 (26.9)

605 (12.8)

236 (5.0)

209 (4.4)

4712 (100.0)

2392

7104

2.25

2.66

Mean

0.66

0.68

0.67

0.65

0.64

0.62

0.66

0.67

0.66

  

S.D.

0.14

0.14

0.12

0.13

0.13

0.14

0.13

0.1

0.13

  

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

Figure 66
Fig. 66

D/P Cr ratio, by primary disease, 2015. Abbreviation: D/P Cr ratio, dialysate/plasma creatinine ratio

Table 72

Prevalent PD patient distribution, by primary disease and D/P Cr ratio, 2015

Primary disease

< 0.5

0.5 ≤, < 0.65

0.65 ≤, < 0.81

0.81 ≤

Subtotal

No information available

Total

Mean

S.D.

Diabetes

30

227

341

145

743

1583

2326

0.70

0.12

Chronic glomerulonephritis

91

320

342

98

851

1295

2146

0.65

0.14

Nephrosclerosis

25

94

145

49

313

630

943

0.68

0.13

PKD

9

36

29

8

82

143

225

0.64

0.13

Chronic pyelonephritis

7

9

11

2

29

49

78

0.60

0.15

Others

59

167

200

42

468

918

1386

  

Subtotal

221

853

1068

344

2486

4618

7104

0.66

0.13

No information available

       

0

0

Total

221

853

1068

344

2486

4618

7104

0.66

0.13

ESI and peritonitis

The patient rate of exit-site infection (ESI) or peritonitis onset was evaluated as the following formula in patients undergoing PD alone. ESI was found in 20.2% of PD patients who responded, and peritonitis was seen in 14.4%. The overall patient ESI incidence rate was 0.40 counts per patient year, and the peritonitis incidence rate was 0.24. (Fig. 67, Table 73).
Figure 67
Fig. 67

Prevalent PD patient distribution, by onset of ESI and peritonitis, 2015. Abbreviation: ESI, exit-site infection

Table 73

Patient’s ESI and peritonitis rate, 2015

 

0

1.0 ≤, < 2.0

2.0 ≤, < 3.0

3.0 ≤, < 4.0

4.0 ≤, < 5.0

5.0 ≤

Subtotal

Unspecified/no information available

Total

Mean

Incidence rates of exit-site infection per single patient (per patient-year)

 Patients (%)

3446 (79.8)

525 (12.2)

169 (3.9)

76 (1.8)

44 (1.0)

59 (1.4)

4319 (100.0)

2785

7104

0.40

 Patients classified in the “0” category denote that they did not experience any exit-site infection during the year

Incidence rates of peritonitis per single patient (per patient-year)

 Patients (%)

3746 (85.6)

443 (10.1)

120 (2.7)

32 (0.7)

13 (0.3)

23 (0.5)

4377 (100.0)

2727

7104

0.24

 Patients classified in the “0” category denote that they did not experience any peritonitis during the year

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

ESI incidence rate (counts/person/year) = ESI episodes in 2015 in all subjects ÷ total months on PD in 2015 in all patients × 12

Peritonitis incidence rate (counts/person/year) = peritonitis episodes in 2015 in all subjects ÷ total months on PD in 2015 in all patients × 12

The peritonitis incidence rate in male PD patients was 0.27, slightly greater than the 0.20 in females. We found an increasing trend in the incidence rate of the older age group (Figs. 68 and 69, Tables 74 and 75). In addition, no consistent trend was found between peritonitis onset and PD vintage (Fig. 70, Table 76). As for primary disease, the peritonitis incidence rate was high in nephrosclerosis (0.26) and diabetic nephropathy (0.27) (Fig. 71, Table 77).
Figure 68
Fig. 68

Patient’s peritonitis rate, by sex, 2015

Figure 69
Fig. 69

Patient’s peritonitis rate, by age, 2015

Table 74

Patient’s peritonitis rate, by sex, 2015

Sex

0

1.0 ≤, < 2.0

2.0 ≤, < 3.0

3.0 ≤, < 4.0

4.0 ≤, < 5.0

5.0 ≤

Subtotal

Unspecified/no information available

Total

Mean

Male (%)

2318 (84.7)

287 (10.5)

84 (3.1)

23 (0.8)

9 (0.3)

17 (0.6)

2738 (100.0)

1762

4500

0.27

Female (%)

1428 (87.1)

156 (9.5)

36 (2.2)

9 (0.5)

4 (0.2)

6 (0.4)

1639 (100.0)

965

2604

0.2

Subtotal (%)

3746 (85.6)

443 (10.1)

120 (2.7)

32 (0.7)

13 (0.3)

23 (0.5)

4377 (100.0)

2727

7104

0.24

No information available (%)

          

Total (%)

3746 (85.6)

443 (10.1)

120 (2.7)

32 (0.7)

13 (0.3)

23 (0.5)

4377 (100.0)

2727

7104

0.24

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

Table 75

Patient’s peritonitis rate, by age, 2015

 

0

1.0 ≤, < 2.0

2.0 ≤, < 3.0

3.0 ≤, < 4.0

4.0 ≤, < 5.0

5.0 ≤

Subtotal

Unspecified/no information available

Total

Mean

S.D.

< 15 (%)

51 (85.0)

6 (10.0)

2 (3.3)

1 (1.7)

  

60 (100.0)

29

89

0.23

0.64

15 ≤, < 30 (%)

50 (87.7)

6 (10.5)

  

1 (1.8)

 

57 (100.0)

31

88

0.20

0.70

30 ≤, < 45 (%)

264 (88.3)

28 (9.4)

4 (1.3)

 

2 (0.7)

1 (0.3)

299 (100.0)

204

503

0.18

0.65

45 ≤, < 60 (%)

955 (88.5)

84 (7.8)

25 (2.3)

7 (0.6)

2 (0.2)

6 (0.6)

1079 (100.0)

647

1726

0.20

0.76

60 ≤, < 75 (%)

1630 (85.3)

200 (10.5)

50 (2.6)

18 (0.9)

4 (0.2)

8 (0.4)

1910 (100.0)

1167

3077

0.25

0.93

75 ≤, < 90 (%)

733 (81.6)

112 (12.5)

36 (4.0)

5 (0.6)

4 (0.4)

8 (0.9)

898 (100.0)

598

1496

0.31

0.84

90 ≤ (%)

63 (85.1)

7 (9.5)

3 (4.1)

1 (1.4)

  

74 (100.0)

51

125

0.23

0.61

Subtotal (%)

3746 (85.6)

443 (10.1)

120 (2.7)

32 (0.7)

13 (0.3)

23 (0.5)

4377 (100.0)

2727

7104

0.24

0.84

No information available (%)

           

Total (%)

3746 (85.6)

443 (10.1)

120 (2.7)

32 (0.7)

13 (0.3)

23 (0.5)

4377 (100.0)

2727

7104

0.24

0.84

Mean

62.99

65.00

67.38

65.59

61.00

66.17

63.34

63.77

63.50

  

S.D.

15.14

15.33

14.63

14.89

17.79

12.98

15.16

14.98

15.09

  

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

Figure 70
Fig. 70

Patient’s peritonitis rate, by PD vintage, 2015

Table 76

Patient’s peritonitis rate, by PD vintage, 2015

PD vintage

0

1.0 ≤, < 2.0

2.0 ≤, < 3.0

3.0 ≤, < 4.0

4.0 ≤, < 5.0

5.0 ≤

Subtotal

Unspecified/no information available

Total

Mean

S.D.

< 1 (%)

1051 (89.1)

56 (4.7)

36 (3.1)

11 (0.9)

6 (0.5)

19 (1.6)

1179 (100.0)

147

1326

0.32

1.20

1 ≤, < 2 (%)

834 (83.6)

120 (12.0)

32 (3.2)

6 (0.6)

4 (0.4)

2 (0.2)

998 (100.0)

69

1067

0.23

0.60

2 ≤, < 4 (%)

1007 (84.3)

145 (12.1)

31 (2.6)

10 (0.8)

 

1 (0.1)

1194 (100.0)

75

1269

0.22

0.79

4 ≤, < 6 (%)

466 (83.5)

78 (14.0)

11 (2.0)

1 (0.2)

1 (0.2)

1 (0.2)

558 (100.0)

47

605

0.20

0.52

6 ≤, < 8 (%)

193 (88.5)

19 (8.7)

4 (1.8)

 

2 (0.9)

 

218 (100.0)

18

236

0.16

0.53

8 ≤, < 10 (%)

76 (85.4)

11 (12.4)

2 (2.2)

   

89 (100.0)

12

101

0.17

0.43

10 ≤ (%)

82 (86.3)

9 (9.5)

3 (3.2)

1 (1.1)

  

95 (100.0)

13

108

0.19

0.53

Subtotal (%)

3709 (85.6)

438 (10.1)

119 (2.7)

29 (0.7)

13 (0.3)

23 (0.5)

4331 (100.0)

381

4712

0.24

0.84

No information available (%)

37 (80.4)

5 (10.9)

1 (2.2)

3 (6.5)

  

46 (100.0)

2346

2392

0.36

0.84

Total (%)

3746 (85.6)

443 (10.1)

120 (2.7)

32 (0.7)

13 (0.3)

23 (0.5)

4377 (100.0)

2727

7104

0.24

0.84

Mean

2.67

3.06

2.44

2.02

2.06

0.68

2.68

2.54

2.67

  

S.D.

2.65

2.44

2.30

2.14

2.45

1.06

2.62

2.91

2.65

  

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

Figure 71
Fig. 71

Patient’s peritonitis rate, by primary disease, 2015

Table 77

Patient’s peritonitis rate, by primary disease, 2015

Primary disease

0

1.0 ≤, < 2.0

2.0 ≤, < 3.0

3.0 ≤, < 4.0

4.0 ≤, < 5.0

5.0 ≤

Subtotal

Unspecified/no information available

Total

Mean

S.D.

Diabetes (%)

1169 (84.6)

144 (10.4)

42 (3.0)

10 (0.7)

6 (0.4)

10 (0.7)

1381 (100.0)

945

2326

0.27

0.88

Chronic glomerulonephritis (%)

1181 (87.3)

127 (9.4)

27 (2.0)

8 (0.6)

5 (0.4)

5 (0.4)

1353 (100.0)

793

2146

0.21

0.86

Nephrosclerosis (%)

503 (83.6)

71 (11.8)

20 (3.3)

4 (0.7)

 

4 (0.7)

602 (100.0)

341

943

0.26

0.84

PKD (%)

119 (86.9)

15 (10.9)

2 (1.5)

  

1 (0.7)

137 (100.0)

88

225

0.19

0.64

Chronic pyelonephritis (%)

53 (88.3)

6 (10.0)

1 (1.7)

   

60 (100.0)

18

78

0.15

0.44

Others (%)

721 (85.4)

80 (9.5)

28 (3.3)

10 (1.2)

2 (0.2)

3 (0.4)

844 (100.0)

542

1386

  

Subtotal (%)

3746 (85.6)

443 (10.1)

120 (2.7)

32 (0.7)

13 (0.3)

23 (0.5)

4377 (100.0)

2727

7104

0.24

0.84

No information available (%)

           

Total (%)

3746 (85.6)

443 (10.1)

120 (2.7)

32 (0.7)

13 (0.3)

23 (0.5)

4377 (100.0)

2727

7104

0.24

0.84

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

History of EPS

The history of encapsulating peritoneal sclerosis (EPS) was observed in 678 (5.2%) patients out of 13,033 patients who were currently undergoing PD or had once underwent PD. This included 86.6% with a history of steroid administration and 79.5% with a history of surgical treatment (Table 78). The breakdown of these 678 patients was 413 males (60.9%) and 265 females (39.1%) (Fig. 72, Table 79). The age distribution largely resembled that for all PD patients (Fig. 47). In terms of relationship to dialysis vintage, 494 patients (72.9%) had a vintage of 8 years or longer, and the incidence rate was significantly high in this category (Fig. 73, Table 80). Regarding primary disease, a significantly high rate was found in 374 patients (55.2%) with chronic glomerulonephritis (Fig. 74, Table 81).
Table 78

Patient with EPS history distribution, by treatment for EPS, 2015

EPS history

No history of EPS

EPS with history of surgical intervention and steroidal use

EPS with history of surgical intervention but without steroid

EPS without surgical intervention but with steroidal use

EPS without surgical intervention or steroidal use

Subtotal

Unspecified

No information available

Total

Patients

12,355

513

26

74

65

13,033

278

3895

17,206

Figure 72
Fig. 72

Patient with EPS history distribution, by age and sex. Abbreviation: EPS, encapsulating peritoneal sclerosis

Table 79

Patient with EPS history distribution, by age and sex, 2015

Sex

< 30

30 ≤, < 45

45 ≤, < 60

60 ≤, < 75

75 ≤

Subtotal

No information available

Total

Mean

S.D.

 Male (%)

1 (0.2)

31 (7.5)

106 (25.7)

227 (55.0)

48 (11.6)

413 (100.0)

 

413

62.56

11.54

 Female (%)

 

23 (8.7)

81 (30.6)

122 (46.0)

39 (14.7)

265 (100.0)

 

265

61.91

12.17

Subtotal (%)

1 (0.1)

54 (8.0)

187 (27.6)

349 (51.5)

87 (12.8)

678 (100.0)

 

678

62.3

11.78

No information available (%)

        

0

0

Total (%)

1 (0.1)

54 (8.0)

187 (27.6)

349 (51.5)

87 (12.8)

678 (100.0)

 

678

62.3

11.78

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

Figure 73
Fig. 73

Patient with EPS history distribution, by dialysis vintage and sex, 2015. Abbreviation: EPS, encapsulating peritoneal sclerosis

Table 80

Patient with EPS history distribution, by dialysis vintage and sex, 2015

Sex

< 2

2 ≤, < 4

4 ≤, < 6

6 ≤, < 8

8 ≤

Subtotal

No information available

Total

Mean

S.D.

Male (%)

18 (4.4)

37 (9.0)

36 (8.7)

35 (8.5)

287 (69.5)

413 (100.0)

 

413

12.6

7.87

Female (%)

9 (3.4)

9 (3.4)

15 (5.7)

25 (9.4)

207 (78.1)

265 (100.0)

 

265

15

8.02

Subtotal (%)

27 (4.0)

46 (6.8)

51 (7.5)

60 (8.8)

494 (72.9)

678 (100.0)

 

678

13.54

8.01

No information available (%)

        

0

0

Total (%)

27 (4.0)

46 (6.8)

51 (7.5)

60 (8.8)

494 (72.9)

678 (100.0)

 

678

13.54

8.01

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

Figure 74
Fig. 74

Patient with EPS history distribution, by primary disease, 2015. Abbreviations: EPS, encapsulating peritoneal sclerosis; PKD, polycystic kidney disease

Table 81

Patient with EPS history distribution, by primary disease and sex, 2015

Primary disease

Male

Female

Subtotal

No information available

Total

Chronic glomerulonephritis (%)

221 (53.5)

153 (57.7)

374 (55.2)

 

374 (55.2)

Chronic pyelonephritis (%)

8 (1.9)

8 (3.0)

16 (2.4)

 

16 (2.4)

RPGN (%)

1 (0.2)

 

1 (0.1)

 

1 (0.1)

PIH (%)

(0.0)

9 (100.0)

9 (100.0)

 

9

Unclassified nephritis (%)

3 (0.7)

1 (0.4)

4 (0.6)

 

4 (0.6)

PKD (%)

12 (2.9)

6 (2.3)

18 (2.7)

 

18 (2.7)

Nephrosclerosis (%)

37 (9.0)

16 (6.0)

53 (7.8)

 

53 (7.8)

Hypertensive emergencies (%)

5 (1.2)

1 (0.4)

6 (0.9)

 

6 (0.9)

Diabetes (%)

73 (17.7)

26 (9.8)

99 (14.6)

 

99 (14.6)

Lupus nephritis (%)

1 (0.2)

6 (2.3)

7 (1.0)

 

7 (1.0)

Amyloidosis (%)

 

1 (0.4)

1 (0.1)

 

1 (0.1)

Gout (%)

2 (0.5)

 

2 (0.3)

 

2 (0.3)

Inborn errors of metabolism (%)

1 (0.2)

 

1 (0.1)

 

1 (0.1)

Tuberculosis (%)

     

Urolithiasis (%)

     

Neoplasm of kidney and urinary tract (%)

2 (0.5)

1 (0.4)

3 (0.4)

 

3 (0.4)

Urinary tract obstruction (%)

     

Myeloma (%)

     

Hypoplastic kidney (%)

2 (0.5)

6 (2.3)

8 (1.2)

 

8 (1.2)

Unspecified (%)

31 (7.5)

17 (6.4)

48 (7.1)

 

48 (7.1)

Rejected kidney (%)

4 (1.0)

4 (1.5)

8 (1.2)

 

8 (1.2)

Others (%)

10 (2.4)

10 (3.8)

20 (2.9)

 

20 (2.9)

Subtotal (%)

413 (100.0)

265 (100.0)

678 (100.0)

 

678 (100.0)

No information available

     

Total

413

265

678

 

678

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

Chapter 5: Current status of elderly dialysis patients

Present status of elderly dialysis patients

We defined dialysis patients who were 75 years or older as “elderly dialysis patients,” and compared categories that were < 60 years, and 60 to 74 years in age. The number of patients in each group was 71,270 patients as < 60 years, 141,634 patients aged 60 to 74 years, and 100,308 patients as 75 years or older. In regard to the male-to-female ratio, males dominated in all age categories, but as age increased, the percentage of females also increased; hence, females accounted 40.8% of elderly dialysis patients (Fig. 75, Table 82). In terms of dialysis vintage, the elderly dialysis patients had the shortest dialysis vintage at 5.71 years, while 54.8% had a vintage of < 5 years and 80.3% had a vintage < 10 years (Fig. 76, Table 83). As for the primary disease among elderly dialysis patients, the percentage of nephrosclerosis was high (16.6%) compared with that among other age groups, whereas the percentages of diabetic nephropathy (34.3%) and chronic glomerulonephritis (26.5%) were low (Fig. 77, Table 84). In past histories of elderly dialysis patients, although the percentages of myocardial infarction, cerebral infarction, and proximal femur fracture were high, no difference was found for cerebral hemorrhage or limb amputation (Fig. 78). Otherwise, history of kidney transplants, history of PD, and smoking were significantly lower than all the other groups (Fig. 79).
Figure 75
Fig. 75

Prevalent dialysis patient distribution, by age and sex, 2015

Table 82

Prevalent dialysis patient distribution, by age and sex, 2015

Sex

< 60

60 ≤,< 75

75 ≤

Subtotal

No information available

Total

Mean

S.D.

Male

49,259

92,729

59,346

201,334

3

201,337

67.07

12.37

Female

22,011

48,905

40,962

111,878

2

111,880

69.28

12.58

Subtotal

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

No information available

        

Total

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

Figure 76
Fig. 76

Prevalent dialysis patient distribution, by age and dialysis vintage, 2015

Table 83

Prevalent dialysis patient distribution, by age and dialysis vintage, 2015

Dialysis vintage

< 60

60 ≤,< 75

75 ≤

Subtotal

No information available

Total

Mean

S.D.

< 5

32,140

60,964

54,911

148,015

2

148,017

68.79

13.05

5 ≤, < 10

17,178

35,102

25,520

77,800

1

77,801

68.18

12.44

10 ≤, < 15

9444

19,440

11,176

40,060

 

40,060

66.98

11.97

15 ≤, < 20

5655

11,221

4679

21,555

 

21,555

65.56

11.44

20 ≤, < 25

3375

6528

2128

12,031

 

12,031

64.75

10.78

25 ≤, < 30

1869

3858

1003

6730

 

6730

64.69

9.76

30 ≤, < 35

994

2448

475

3917

 

3917

64.64

8.76

35 ≤, < 40

441

1431

224

2096

 

2096

65.24

7.28

40 ≤

82

489

46

617

 

617

65.95

5.97

Subtotal

71,178

141,481

100,162

312,821

3

312,824

67.86

12.49

No information available

92

153

146

391

2

393

68.35

12.98

Total

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

Mean

7.78

8.21

5.71

7.31

2.33

7.31

  

S.D.

7.76

8.21

6.01

7.55

2.52

7.55

  
Figure 77
Fig. 77

Prevalent dialysis patient distribution, by age and primary disease, 2015. Abbreviations: RPGN: rapidly progressive glomerulonephritis; PKD, polycystic kidney disease

Table 84

Prevalent dialysis patient distribution, by age and primary disease, 2015

Primary disease

< 60

60 ≤, < 75

75 ≤

Subtotal

No information available

Total

Mean

S.D.

Diabetes

26,742

59,129

34,405

120,276

2

120,278

67.52

11.33

Chronic glomerulonephritis

22,999

43,758

26,589

93,346

1

93,347

66.90

12.46

Nephrosclerosis

3292

9867

16,646

29,805

 

29,805

74.25

11.74

PKD

3273

5624

2359

11,256

 

11,256

65.16

11.37

Chronic pyelonephritis

863

1254

818

2935

 

2935

65.62

13.84

RPGN

469

1064

945

2478

 

2478

69.23

12.93

Lupus nephritis

898

932

397

2227

 

2227

61.64

13.68

Others

12,731

19,996

18,141

50,868

2

50,870

  

Subtotal

71,267

141,624

100,300

313,191

5

313,196

67.86

12.49

No information available

3

10

8

21

 

21

70.52

11.36

Total

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

Figure 78
Fig. 78

Prevalent dialysis patient distribution, by comorbidity and age, 2015

Figure 79
Fig. 79

Prevalent dialysis patient distribution, by history of kidney transplantation and peritoneal dialysis, smoking status and age, 2015

Hemodynamics, dialysis prescriptions, and urea kinetics in elderly dialysis patients

The mean blood pressure and pulse rate of elderly dialysis patients were 149/72 mmHg and 72 bpm, respectively. Both blood pressure and pulse showed a decreasing trend as age increased (Fig. 80, Table 85). Particularly, in a comparison of blood pressure, the decrease in diastolic blood pressure was pronounced compared with systolic blood pressure, suggesting that the pulse pressure increases with aging. We compared Kt/Vsp as an index of dialysis efficiency, but no clear difference was found by age (Fig. 81, Table 86). The mean dialysis time in elderly dialysis patients was 3.85 h, which was shorter than in other groups, with 27.2% at < 4 h. (Fig. 82, Table 87) The mean blood flow rate among elderly dialysis patients was 195 mL/min, which was the lowest among different groups, wherein 36.0% had a blood flow rate < 200 mL/min (Fig. 83, Table 88).
Figure 80
Fig. 80

Blood pressure and pulse rate, by age, 2015

Table 85

Blood pressure and pulse rate, by age, 2015

  

< 60

60 ≤, < 75

75 ≤

Systolic blood pressure

Mean

153.62

152.35

148.81

S.D.

24.90

24.12

24.40

Diastolic blood pressure

Mean

86.23

78.10

71.96

S.D.

14.65

13.36

13.15

Pulse rate

Mean

79.16

74.11

71.78

S.D.

12.69

12.33

12.44

Figure 81
Fig. 81

Kt/Vsp, by sex and age, 2015

Table 86

Kt/Vsp, by age and sex, 2015

  

< 60

60 ≤, < 75

75 ≤

Male

Mean

1.41

1.43

1.42

S.D.

0.27

0.25

0.25

Female

Mean

1.66

1.67

1.62

S.D.

0.33

0.31

0.31

Kt/Vsp was summarized in the patients with vintages of 2 years or more and receiving dialysis three times a week

Figure 82
Fig. 82

Prevalent dialysis patient distribution, by age and dialysis time, 2015

Table 87

Prevalent patient distribution, by age and dialysis time, 2015

Dialysis time(hour)

< 60

60 ≤, < 75

75 ≤

Subtotal

Unspecified/no information available

Total

Mean

S.D.

< 3.5

3947

11,187

15,515

30,649

1

30,650

72.96

12.09

3.5 ≤, < 4.0

3142

8734

9277

21,153

 

21,153

71.35

11.89

4.0 ≤, < 4.5

42,258

89,656

59,453

191,367

2

191,369

67.82

12.09

4.5 ≤, < 5.0

5526

7644

2945

16,115

 

16,115

63.45

12.18

5.0 ≤, < 5.5

7539

9636

3415

20,590

 

20,590

62.63

12.36

5.5 ≤

1407

1351

431

3189

 

3189

60.66

12.53

Subtotal

63,819

128,208

91,036

283,063

3

283,066

67.93

12.41

No information available

7451

13,426

9272

30,149

2

30,151

67.17

13.25

Total

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

Mean

4.14

4.02

3.85

3.99

3.67

3.99

  

S.D.

0.59

0.50

0.50

0.53

0.58

0.53

  
Figure 83
Fig. 83

Prevalent dialysis patient distribution, by age and blood flow rate, 2015

Table 88

Prevalent dialysis patient distribution, by age and blood flow rate, 2015

Blood flow rate

< 60

60 ≤, < 75

75 ≤

Subtotal

Unspecified/no information available

Total

Mean

S.D.

< 120

115

354

528

997

 

997

73.4

12.65

120 ≤, < 160

2196

7680

13,234

23,110

 

23,110

74.75

11.59

160 ≤, < 200

4789

16,219

18,643

39,651

 

39,651

72.42

11.43

200 ≤, < 240

33,098

75,499

48,379

156,976

1

156,977

67.96

11.8

240 ≤, < 280

16,423

21,342

7437

45,202

 

45,202

62.7

12.12

280 ≤

6602

5776

1701

14,079

1

14,080

59.89

12.25

Subtotal

63,223

126,870

89,922

280,015

2

280,017

67.92

12.41

No information available

8047

14,764

10,386

33,197

3

33,200

67.38

13.19

Total

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

Mean

224.78

210.69

195.43

208.97

350.00

208.97

  

S.D.

40.53

35.94

34.24

38.07

212.13

38.07

  

Nutrition and inflammation in elderly dialysis patients

Serum albumin concentration, creatinine concentration, %CGR, and nPCR all decreased as age increased and were lowest in elderly dialysis patients (Fig. 84, Table 89). Among these, no difference was found between men and women for albumin concentration and %CGR, but males tended to be high in creatinine concentration, and females showed a high trend for nPCR. Serum CRP concentration increased with age, and among different groups, the elderly group was the highest. Between sexes, males showed a slightly high trend.
Figure 84
Fig. 84

Nutrition and inflammation indices, by sex and age, 2015

Table 89

Nutrition and inflammation indices, by sex and age, 2015

Serum albumin (g/dL)

  
  

< 60

60 ≤, < 75

75 ≤

Male

Mean

3.78

3.6

3.42

S.D.

0.4

0.42

0.44

Female

Mean

3.7

3.58

3.38

S.D.

0.39

0.41

0.45

Pre-dialysis serum creatinine (mg/dL)a

  

< 60

60 ≤, < 75

75 ≤

Male

Mean

12.86

10.96

9.36

S.D.

2.72

2.46

2.30

Female

Mean

10.83

9.34

7.90

S.D.

2.20

2.05

2.00

Percent creatinine generation rate(%)a

  

< 60

60 ≤, < 75

75 ≤

Male

Mean

100.98

99.93

96.36

S.D.

22.96

25.33

27.46

Female

Mean

102.1

100.33

94.35

S.D.

23.32

25.36

28.05

Normalized protein catabolic rate(g/kg/day) a

  

< 60

60 ≤, < 75

75 ≤

Male

Mean

0.89

0.86

0.82

S.D.

0.17

0.17

0.17

Female

Mean

0.93

0.90

0.84

S.D.

0.18

0.18

0.18

Serum CRP level (mg/dL)

  
  

< 60

60 ≤, < 75

75 ≤

Male

Mean

0.48

0.64

0.82

S.D.

1.59

1.86

2.01

Female

Mean

0.41

0.53

0.7

S.D.

1.43

1.66

1.96

aCreatinine concentration, %CGR, and nPCR were summarized in the patients with vintages of 2 years or more and receiving dialysis three times a week

Management for anemia and CKD-MBD in elderly dialysis patients

Hemoglobin concentration showed a tendency to decrease as age increased. The mean hemoglobin concentration in elderly dialysis patients was lowest at 10.6 g/dL (Fig. 85, Table 90), wherein 27.2% of elderly dialysis patients had < 10 g/dL. Serum phosphorus concentration and intact PTH concentration also showed a decreasing trend as age increased (Figs. 86 and 87, Tables 91 and 92). The mean phosphorus concentration in elderly dialysis patients was 4.9 mg/dL, and the intact PTH concentration was 162 pg/mL, which were the lowest values between different groups. Hypophosphatemia (< 3.5 mg/dL) and hypoparathyroidism (< 60 pg/mL), less than reference values in the CKD-MBD guidelines, were found in 12.9 and 20.2% of elderly dialysis patients, respectively. In contrast, no difference was found in corrected calcium concentration between groups (Fig. 88, Table 93).
Figure 85
Fig. 85

Prevalent dialysis patient distribution, by age and hemoglobin concentration, 2015

Table 90

Prevalent dialysis patient distribution, by age and hemoglobin concentration, 2015

Hemoglobin concentration

< 60

60 ≤, < 75

75 ≤

Subtotal

Unspecified/no information available

Total

Mean

S.D.

< 9.0

3348

8673

7940

19,961

 

19,961

70.27

12.21

9.0 ≤, < 10.0

8218

19,957

16,494

44,669

2

44,671

69.53

12.14

10.0 ≤, < 11.0

20,115

42,987

31,141

94,243

 

94,243

68.30

12.24

11.0 ≤, < 12.0

20,067

37,275

23,636

80,978

 

80,978

66.99

12.48

12.0 ≤, < 12.1

1427

2347

1436

5210

 

5210

66.21

12.78

12.1 ≤, < 13.0

7166

11,634

6796

25,596

 

25,596

65.91

12.74

13.0 ≤

3699

4788

2368

10,855

 

10,855

64.04

12.84

Subtotal

64,040

127,661

89,811

281,512

2

281,514

67.84

12.46

No information available

7230

13,973

10,497

31,700

3

31,703

68.03

12.82

Total

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

Mean

10.97

10.77

10.58

10.75

9.60

10.75

  

S.D.

1.31

1.27

1.26

1.28

0.28

1.28

  
Figure 86
Fig. 86

Prevalent dialysis patient distribution, by age and phosphorus concentration, 2015

Figure 87
Fig. 87

Prevalent dialysis patient distribution, by age and intact PTH concentration, 2015

Table 91

Prevalent dialysis patient distribution, by age and phosphorus concentration, 2015

Phosphorus concentration

< 60

60 ≤, < 75

75 ≤

Subtotal

Unspecified/no information available

Total

Mean

S.D.

< 3.0

1191

4245

5523

10,959

1

10,960

73.26

11.36

3.0 ≤, < 3.5

1821

5413

6123

13,357

 

13,357

71.88

11.78

3.5 ≤, < 4.0

3576

9941

9584

23,101

 

23,101

70.84

11.81

4.0 ≤, < 5.0

13,960

34,877

27,391

76,228

 

76,228

69.36

11.86

5.0 ≤, < 6.0

18,491

38,269

24,050

80,810

 

80,810

67.49

12.08

6.0 ≤, < 6.1

1650

2998

1781

6429

 

6429

66.65

12.36

6.1 ≤, < 7.0

11,687

19,548

10,027

41,262

1

41,263

65.56

12.42

7.0 ≤

12,098

13,055

5818

30,971

 

30,971

62.37

13.34

Subtotal

64,474

128,346

90,297

283,117

2

283,119

67.84

12.46

No information available

6796

13,288

10,011

30,095

3

30,098

68.09

12.78

Total

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

Mean

5.73

5.27

4.89

5.25

4.60

5.25

  

S.D.

1.56

1.37

1.35

1.44

3.25

1.44

  
Table 92

Prevalent dialysis patient distribution, by age and intact PTH concentration, 2015

Intact PTH concentration

< 60

60 ≤, < 75

75 ≤

Subtotal

Unspecified/no information available

Total

Mean

S.D.

< 60

8217

19,826

15,636

43,679

1

43,680

69.26

12.09

60 ≤, < 120

11,467

26,155

19,564

57,186

 

57,186

68.73

12.07

120 ≤, < 240

19,662

39,949

27,361

86,972

 

86,972

67.82

12.29

240 ≤, < 241

115

205

134

454

 

454

66.9

12.56

241 ≤, < 300

5552

9678

6040

21,270

 

21,270

66.63

12.58

300 ≤, < 500

7267

11,075

6612

24,954

 

24,954

65.67

12.95

500 ≤

3291

3824

1974

9089

 

9089

63.25

13.84

Subtotal

55,571

110,712

77,321

243,604

1

243,605

67.8

12.44

No information available

15,699

30,922

22,987

69,608

4

69,612

68.08

12.68

Total

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

Mean

208.85

176.51

162.00

179.28

16.00

179.28

  

S.D.

208.72

164.75

147.92

171.8

0.00

171.8

  
Figure 88
Fig. 88

Prevalent dialysis patient distribution, by age and corrected calcium concentration, 2015

Table 93

Prevalent dialysis patient distribution, by age and corrected calcium concentration, 2015

Corrected calcium concentration

< 60

60 ≤, < 75

75 ≤

Subtotal

Unspecified/no information available

Total

Mean

S.D.

< 8.0

2897

4426

2484

9807

 

9807

65.32

13.03

8.0 ≤, < 8.4

4606

8560

5607

18,773

 

18,773

67.13

12.42

8.4 ≤, < 9.0

17,055

34,307

24,678

76,040

1

76,041

67.94

12.45

9.0 ≤, < 10.0

31,271

62,486

44,801

138,558

 

138,558

67.98

12.46

10 ≤, < 10.1

1527

3158

2141

6826

1

6827

67.87

12.35

10.1 ≤, < 11.0

5438

11,901

7991

25,330

 

25,330

68.1

12.12

11.0 ≤

811

2054

1650

4515

 

4515

69.34

12.6

Subtotal

63,605

126,892

89,352

279,849

2

279,851

67.85

12.46

No information available

7665

14,742

10,956

33,363

3

33,366

67.95

12.8

Total

71,270

141,634

100,308

313,212

5

313,217

67.86

12.49

Mean

9.15

9.19

9.20

9.18

9.45

9.18

  

S.D.

0.76

0.75

0.74

0.75

0.78

0.75

  

Chapter 6: Current status of diabetic dialysis patients

Present status of diabetic dialysis patients

“Diabetic dialysis patients” was defined as patients for whom diabetic nephropathy was the primary disease or who had a history of diabetes. Of 271,337 dialysis patients who responded, 144,870 were diabetic dialysis patients, accounting for 53.4% of the total. The diabetes prevalence was slightly higher in males as 57.5% than females as 45.8% (Fig. 89, Table 94). The diabetes prevalence become higher as the patients got older: 40% in the patient category older than 30 years old and 56.5% in the category older than 60 years and younger than 75 years (Fig. 90, Table 95). In addition, diabetes prevalence decreased as dialysis vintage got longer, and when dialysis vintage reached 25 years or longer, the percentage of diabetic dialysis patients was < 10% (Fig. 91, Table 96). The percentages of past history of myocardial infarction, cerebral infarction, and limb amputation were clearly higher among diabetic dialysis patients (Fig. 92). In contrast, no clear difference was found in cerebral hemorrhage and proximal femur fracture whether diabetes was present. Otherwise, no significant difference was found in past history of kidney transplants and PD among diabetic dialysis patients, whereas smokers were relatively numerous (Fig. 93).
Figure 89
Fig. 89

Prevalent dialysis patient distribution, by sex and presence of diabetes, 2015

Table 94

Prevalent dialysis patient distribution, by sex and presence of diabetes, 2015

Sex

With diabetes

Without diabetes

Subtotal

Unspecified

No information available

Total

Male

101,294

74,966

176,260

25,071

6

201,337

Female

43,576

51,501

95,077

16,802

1

111,880

Subtotal

144,870

126,467

271,337

41,873

7

313,217

No information available

      

Total

144,870

126,467

271,337

41,873

7

313,217

Figure 90
Fig. 90

Patient distribution, by age and presence of diabetes, 2015

Table 95

Patient distribution, by age and presence of diabetes, 2015

Age

With diabetes

Without diabetes

Subtotal

Unspecified

No information available

Total

< 15

3

68

71

32

 

103

15 ≤, < 30

70

687

757

213

 

970

30 ≤, < 45

4736

6964

11,700

2155

1

13,856

45 ≤, < 60

25,919

23,059

48,978

7363

 

56,341

60 ≤, < 75

69,955

53,880

123,835

17,796

3

141,634

75 ≤, < 90

42,473

38,958

81,431

13,314

3

94,748

90 ≤

1711

2850

4561

999

 

5560

Subtotal

144,867

126,466

271,333

41,872

7

313,212

No information available

3

1

4

1

 

5

Total

144,870

126,467

271,337

41,873

7

313,217

Mean

68.01

67.62

67.83

68.03

69.71

67.86

S.D.

11.42

13.37

12.37

13.26

15.09

12.49

Figure 91
Fig. 91

Prevalent dialysis patient distribution, by dialysis vintage and presence of diabetes, 2015

Table 96

Prevalent dialysis patient distribution, by dialysis vintage and presence of diabetes, 2015

Dialysis vintage

With diabetes

Without diabetes

Subtotal

Unspecified

No information available

Total

< 5

81,726

49,115

130,841

17,169

7

148,017

5 ≤, < 10

40,416

28,026

68,442

9359

0

77,801

10 ≤, < 15

15,681

18,433

34,114

5946

0

40,060

15 ≤, < 20

4741

12,929

17,670

3885

0

21,555

20 ≤, < 25

1371

8232

9603

2428

0

12,031

25 ≤, < 30

451

4794

5245

1485

0

6730

30 ≤, < 35

196

2880

3076

841

0

3917

35 ≤, < 40

98

1530

1628

468

0

2096

40 ≤

22

476

498

119

0

617

Subtotal

144,702

126,415

271,117

41,700

7

312,824

Unspecified

168

51

219

173

 

392

No information available

 

1

1

  

1

Total

144,870

126,467

271,337

41,873

7

313,217

Mean

5.03

9.40

7.07

8.90

1.29

7.31

S.D.

4.84

8.87

7.34

8.63

1.11

7.55

Figure 92
Fig. 92

Prevalent dialysis patient distribution, by major past history and presence of diabetes, 2015

Figure 93
Fig. 93

Prevalent dialysis patient distribution, by history of kidney transplantation and peritoneal dialysis, smoking status and presence of diabetes, 2015

Hemodynamics, dialysis prescriptions, and urea kinetics in diabetic dialysis patients

The mean systolic blood pressure in diabetic dialysis patients was 156 mmHg, which was high compared with 147 mmHg in the non-diabetic group. However, diastolic blood pressure showed no difference between patients and was 78 mmHg for all. Pulse rate was 75 and 74 bpm, respectively; thus, practically no difference was found between groups (Fig. 94, Table 97). When we compared Kt/Vsp as an index of dialysis efficiency, both male and female diabetic dialysis patients showed a low trend (Fig. 95, Table 98). Comparing dialysis prescriptions, no difference was found in dialysis time and blood flow rate between groups, and distributions were also largely the same (Figs. 96 and 97, Tables 99 and 100). Although no major differences were found in dialysis prescriptions between groups, certain differences were found in hemodynamics and urea kinetics.
Figure 94
Fig. 94

Blood pressure and pulse rate, by presence of diabetes, 2015

Table 97

Blood pressure and pulse rate, by presence of diabetes, 2015

  

With diabetes

Without diabetes

Systolic blood pressure

Mean

156.05

147.46

S.D.

24.8

23.42

Diastolic blood pressure

Mean

77.58

78.37

S.D.

14.52

14.59

Pulse rate

Mean

75.42

73.68

S.D.

12.85

12.6

Figure 95
Fig. 95

Kt/Vsp, by sex and presence of diabetes, 2015

Table 98

Kt/Vsp, by presence of diabetes and sex, 2015

  

With diabetes

Without diabetes

Male

Mean

1.38

1.46

S.D.

0.25

0.26

Female

Mean

1.57

1.70

S.D.

0.30

0.31

Kt/Vsp was summarized in the patients with vintages of 2 years or more and receiving dialysis three times a week

Figure 96
Fig. 96

Prevalent dialysis patient distribution, by presence of diabetes and dialysis time, 2015

Figure 97
Fig. 97

Prevalent dialysis patient distribution, by presence of diabetes and blood flow rate, 2015

Table 99

Prevalent dialysis patient distribution, by presence of diabetes and dialysis time, 2015

Dialysis time (hour)

With diabetes

Without diabetes

Subtotal

Unspecified

No information available

Total

< 3.5

14,900

12,661

27,561

3088

1

30,650

3.52 ≤, < 4.0

10,242

8826

19,068

2085

 

21,153

4.0 ≤, < 4.5

90,319

81,423

171,742

19,627

 

191,369

4.5 ≤, < 5.0

6606

7938

14,544

1571

 

16,115

5.0 ≤, < 5.5

8999

9693

18,692

1898

 

20,590

5.5 ≤

1215

1720

2935

254

 

3189

Subtotal

132,281

122,261

254,542

28,523

1

283,066

No information available

12,589

4206

16,795

13,350

6

30,151

Total

144,870

126,467

271,337

41,873

7

313,217

Mean

3.97

4.01

3.99

3.99

3.00

3.99

S.D.

0.52

0.56

0.54

0.52

0.00

0.54

Table 100

Prevalent dialysis patient distribution, by presence of diabetes and blood flow rate, 2015

Blood flow rate

With diabetes

Without diabetes

Subtotal

Unspecified

No information available

Total

< 120

513

346

859

138

 

997

120 ≤, < 160

11,303

9620

20,923

2187

 

23,110

160 ≤, < 200

18,601

17,201

35,802

3849

 

39,651

200 ≤, < 240

73,929

67,909

141,838

15,139

 

156,977

240 ≤, < 280

20,384

20,233

40,617

4585

 

45,202

280 ≤

6204

6442

12,646

1434

 

14,080

Subtotal

130,934

121,751

252,685

27,332

 

280,017

No information available

13,936

4716

18,652

14,541

7

33,200

Total

144,870

126,467

271,337

41,873

7

313,217

Mean

207.97

209.85

208.87

209.90

0.00

208.97

S.D.

37.59

38.37

37.98

38.94

0.00

38.07

Nutrition and inflammation in diabetic dialysis patients

We compared indices for diabetic dialysis patient nutrition and inflammation to those of patients without diabetes. Albumin concentration in diabetic patients was the same as that in non-diabetic patients, whether male or female. In contrast, creatinine concentration, %CGR, and nPCR showed a low trend for both males and females among diabetic dialysis patients. CRP concentration showed a high trend among diabetic patients that was more prominent among females (Fig. 98, Table 101).
Figure 98
Fig. 98

Nutrition and inflammation indices, by sex and presence of diabetes, 2015

Table 101

Nutrition and inflammation indices, by sex and presence of diabetes, 2015

Serum albumin (g/dL)

 
  

With diabetes

Without diabetes

Male

Mean

3.58

3.60

S.D.

0.45

0.43

Female

Mean

3.50

3.55

S.D.

0.44

0.43

Pre-dialysis serum creatinine (mg/dL)a

  

With diabetes

Without diabetes

Male

Mean

10.46

11.49

S.D.

2.64

2.83

Female

Mean

8.52

9.52

S.D.

2.23

2.29

Percent creatinine generation rate(%)a

  

With diabetes

Without diabetes

Male

Mean

93.64

104.54

S.D.

24.91

24.75

Female

Mean

90.29

103.75

S.D.

25.70

25.03

Normalized protein catabolic rate(g/kg/day)a

  

With diabetes

Without diabetes

Male

Mean

0.83

0.88

S.D.

0.17

0.17

Female

Mean

0.85

0.91

S.D.

0.18

0.18

Serum CRP level (mg/dL)

 
  

With diabetes

Without diabetes

Male

Mean

0.67

0.63

S.D.

1.92

1.78

Female

Mean

0.65

0.51

S.D.

1.94

1.59

aCreatinine concentration, %CGR, and nPCR were summarized in the patients with vintages of 2 years or more and receiving dialysis three times a week

Management for anemia and CKD-MBD in diabetic dialysis patients

The mean hemoglobin concentration in diabetic dialysis patients was 10.7 g/dL, which was largely equal to the 10.8 g/dL in non-diabetic patients (Fig. 99, Table 102). The serum phosphorus concentration was 5.2 and 5.3 mg/dL for dialysis patients with and without diabetes, revealing almost no difference (Fig. 100, Table 103). Furthermore, the corrected calcium concentration also showed no difference, with a mean of 9.1 and 9.2 mg/dL, respectively (Fig. 101, Table 104). Intact PTH concentration was 189 pg/mL for non-diabetic patients, whereas it was slightly lower for diabetic dialysis patients at 169 pg/mL (Fig. 102, Table 105).
Figure 99
Fig. 99

Prevalent dialysis patient distribution, by presence of diabetes and hemoglobin concentration, 2015

Table 102

Prevalent dialysis patient distribution, by presence of diabetes and hemoglobin concentration, 2015

Hemoglobin concentration

With diabetes

Without diabetes

Subtotal

Unspecified

No information available

Total

< 9.0

9802

8286

18,088

1873

 

19,961

9.0 ≤, < 10.0

21,256

19,273

40,529

4142

 

44,671

10.0 ≤, < 11.0

43,785

41,448

85,233

9010

 

94,243

11.0 ≤, < 12.0

36,953

36,123

73,076

7902

 

80,978

12.0 ≤, < 12.1

2372

2288

4660

550

 

5210

12.1 ≤, < 13.0

12,036

11,116

23,152

2443

1

25,596

13.0 ≤

5226

4545

9771

1083

1

10,855

Subtotal

131,430

123,079

254,509

27,003

2

281,514

No information available

13,440

3388

16,828

14,870

5

31,703

Total

144,870

126,467

271,337

41,873

7

313,217

Mean

10.74

10.77

10.75

10.76

12.85

10.75

S.D.

1.30

1.25

1.28

1.31

0.78

1.28

Figure 100
Fig. 100

Prevalent dialysis patient distribution, by presence of diabetes and phosphorus concentration, 2015

Table 103

Prevalent dialysis patient distribution, by presence of diabetes and phosphorus concentration, 2015

Phosphorus concentration

With diabetes

Without diabetes

Subtotal

Unspecified

No information available

Total

< 3.0

5457

4477

9934

1026

 

10,960

3.0 ≤, < 3.5

6420

5702

12,122

1235

 

13,357

3.5 ≤, < 4.0

11,150

9794

20,944

2157

 

23,101

4.0 ≤, < 5.0

35,652

33,130

68,782

7446

 

76,228

5.0 ≤, < 6.0

36,565

36,304

72,869

7940

1

80,810

6.0 ≤, < 6.1

2950

2864

5814

615

 

6429

6.1 ≤, < 7.0

19,161

18,071

37,232

4030

1

41,263

7.0 ≤

14,657

13,251

27,908

3063

 

30,971

Subtotal

132,012

123,593

255,605

27,512

2

283,119

No information available

12,858

2874

15,732

14,361

5

30,098

Total

144,870

126,467

271,337

41,873

7

313,217

Mean

5.24

5.26

5.25

5.28

5.90

5.25

S.D.

1.46

1.42

1.44

1.45

0.99

1.44

Figure 101
Fig. 101

Prevalent dialysis patient distribution, by presence of diabetes and corrected calcium concentration, 2015

Table 104

Prevalent dialysis patient distribution, by presence of diabetes and corrected calcium concentration, 2015

Corrected calcium concentration

With diabetes

Without diabetes

Subtotal

Unspecified

No information available

Total

< 8.0

4905

4079

8984

822

1

9807

8.0 ≤, < 8.4

9625

7406

17,031

1742

 

18,773

8.4 ≤, < 9.0

38,384

30,749

69,133

6908

 

76,041

9.0 ≤, < 10.0

63,194

61,694

124,888

13,669

1

138,558

10 ≤, < 10.1

2743

3395

6138

689

 

6827

10.1 ≤, < 11.0

10,086

12,521

22,607

2723

 

25,330

11.0 ≤

1736

2261

3997

518

 

4515

Subtotal

130,673

122,105

252,778

27,071

2

279,851

No information available

14,197

4362

18,559

14,802

5

33,366

Total

144,870

126,467

271,337

41,873

7

313,217

Mean

9.13

9.23

9.18

9.23

8.45

9.18

S.D.

0.73

0.76

0.75

0.75

0.78

0.75

Figure 102
Fig. 102

Prevalent dialysis patient distribution, by presence of diabetes and intact PTH concentration, 2015

Table 105

Prevalent dialysis patient distribution, by presence of diabetes and intact PTH concentration, 2015

Intact PTH concentration

With diabetes

Without diabetes

Subtotal

Unspecified

No information available

Total

< 60

21,129

18,568

39,697

3981

2

43,680

60 ≤, < 120

27,332

24,645

51,977

5209

 

57,186

120 ≤, < 240

40,815

37,850

78,665

8307

 

86,972

240 ≤, < 241

211

201

412

42

 

454

241 ≤, < 300

9665

9551

19,216

2054

 

21,270

300 ≤, < 500

10,687

11,774

22,461

2493

 

24,954

500 ≤

3213

4865

8078

1011

 

9089

Subtotal

113,052

107,454

220,506

23,097

2

243,605

No information available

31,818

19,013

50,831

18,776

5

69,612

Total

144,870

126,467

271,337

41,873

7

313,217

Mean

168.86

188.62

178.49

186.86

10.00

179.28

S.D.

147.42

191.34

170.53

183.28

1.41

171.80

Annual changes in diabetic dialysis patient dynamics

A survey of diabetes prevalence was started from 2013 (In the 2013 survey, patients with diabetes were defined as having a history of diabetes, or having used three types of diabetes therapeutics. Primary disease was not considered). The dynamics of diabetic dialysis patients from 2013 to 2015 are shown in the figure (Fig. 103, Table 106). The number of diabetic dialysis patients, both males and females, showed an increasing trend over time. This was more pronounced among males, but hardly any difference was found overall in the male-to-female ratio. A slight difference was found relative to age with an increasing trend seen from 67.5 to 67.8 years and thereafter to 68.0 years. Differences relative to dialysis vintage were also found, which gradually got longer from 4.87 to 4.92 and 5.03 years (Fig. 104, Table 107, Fig. 105, Table 108).
Figure 103
Fig. 103

Diabetic dialysis patient distribution, by sex, 2013–2015

Table 106

Diabetic dialysis patient distribution, by sex, 2013–2015

Sex

2013

 

2014

 

2015

 

Male

90,492

(69.2)

96,863

(69.6)

101,294

(69.9)

Female

40,344

(30.8)

42,390

(30.4)

43,576

(30.1)

Subtotal

130,836

(100.0)

139,253

(100.0)

144,870

(100.0)

No information available

0

 

0

 

0

 

Total

130,836

 

139,253

 

144,870

 

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

Figure 104
Fig. 104

Diabetic dialysis patient distribution, by age, 2013–2015

Table 107

Diabetic dialysis patient distribution, by age, 2013–2015

Age

2013

 

2014

 

2015

 

< 40

1662

(1.3)

1633

(1.2)

1606

(1.1)

40 ≤, < 50

8193

(6.3)

8672

(6.2)

8875

(6.1)

50 ≤, < 60

18,633

(14.2)

19,585

(14.1)

20,247

(14.0)

60 ≤, < 70

42,870

(32.8)

44,621

(32.0)

46,379

(32.0)

70 ≤, < 80

40,778

(31.2)

43,685

(31.4)

44,347

(30.6)

80 ≤

18,698

(14.3)

21,051

(15.1)

23,413

(16.2)

Subtotal

130,834

(100.0)

139,247

(100.0)

144,867

(100.0)

Unspecified/no information available

2

 

6

 

3

 

Total

130,836

 

139,253

 

144,870

 

Mean

67.48

 

67.75

 

68.01

 

S.D.

11.31

 

11.36

 

11.42

 

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

Figure 105
Fig. 105

Diabetic dialysis patient distribution, by dialysis vintage, 2013–2015

Table 108

Diabetic dialysis patient distribution, by dialysis vintage, 2013–2015

Dialysis vintage

2013

 

2014

 

2015

 

< 5

75,087

(57.4)

79,337

(57.0)

81,726

(56.5)

5 ≤, < 10

37,047

(28.3)

39,189

(28.1)

40,416

(27.9)

10 ≤, < 15

13,209

(10.1)

14,557

(10.5)

15,681

(10.8)

15 ≤, < 20

3869

(3.0)

4293

(3.1)

4741

(3.3)

20 ≤, < 25

977

(0.7)

1199

(0.9)

1371

(0.9)

25 ≤, < 30

366

(0.3)

391

(0.3)

451

(0.3)

30 ≤

241

(0.2)

256

(0.2)

316

(0.2)

Subtotal

130,796

(100.0)

139,222

(100.0)

144,702

(100.0)

Unspecified/no information available

40

 

31

 

168

 

Total

130,836

 

139,253

 

144,870

 

Mean

4.87

 

4.92

 

5.03

 

S.D.

4.65

 

4.73

 

4.84

 

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

Conclusions

In a summary of 2015 JRDR survey, chronic dialysis patients and dialysis facilities had been still increasing but the increasing rates had been gradually slowing in Japan. The average ages of incident and prevalent dialysis patients had been also glowing as up to 70 years old. Most of dialysis patients had been treated by in-center dialysis, and PD patient count had been slightly decreased. The combination therapy with PD and HDF is one of the unique points of the Japanese PD style, even if they start the combination therapy just after the dialysis initiation. The percentage of home dialysis defined as PD and HHD was quite as low as 3.0% of all dialysis patients, and Japan was one of the lowest countries in the penetration of home dialysis. A well-balanced dialysis modality choice might be needed in the future when home cares for elder dialysis patients would be needed. Online HDF had been rapidly increasing more and more just after the revision of medical reimbursement for online HDF in 2012, and the percentage of all convective therapy was 17% of all dialysis patients. The Japanese style online HDF is very unique compared with the worldwide standard method, so the evidence of it should be established in Japan. Further JRDR data analyses could clarify the relationships between various dialysis modalities, patient care, and clinical outcomes; furthermore, it could also make it possible to establish clinical practice guidelines or medical reimbursement revisions based on the evidence.

Abbreviations

AFBF: 

Acetate-free biofiltration

APD: 

Automated peritoneal dialysis

CRP: 

C-reactive protein

D/P Cr ratio: 

Dialysate/plasma creatinine ratio

EPS: 

Encapsulating peritoneal sclerosis

ESI: 

Exit-site infection

ETRF: 

Endotoxin retentive filter

HD: 

Hemodialysis

HDF: 

Hemodiafiltration

HDL-C: 

High-density lipoprotein cholesterol concentration

HHD: 

Home hemodialysis

JRDR: 

JSDT Renal Data Registry

JSDT: 

Japanese Society for Dialysis Therapy

Kt/V

Index for standardized dialysis dose defined as follows: K is the urea clearance, t is the dialysis time, V is the body fluid volume

PD: 

Peritoneal dialysis

PET: 

Peritoneal equilibration test

PIH: 

Pregnancy-induced hypertension

PKD: 

Polycystic kidney disease

pmp: 

Per million of the population

PTH: 

Parathyroid hormone

RPGN: 

Rapidly progressive glomerulonephritis

TVC: 

Total viable microbial count

UMIN: 

University hospital Medical Information Network

UMIN-CTR: 

the UMIN Clinical Trials Registry

UN: 

urea N

USB: 

Universal serial bus

Declarations

Acknowledgements

We owe the completion of this survey to the efforts of the members of the subcommittee of the District Cooperative Committee members mentioned as followings and the staff members of the 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, and Yoshinori Oshiro.

This article is translated from Japanese, originally published as “Annual dialysis data report 2015, JSDT Registry” in the Journal of the Japanese Society for Dialysis Therapy, 2017; 50: 1-62 with permission from Japanese Society for Dialysis Therapy. The original work is at “https://www.jstage.jst.go.jp/article/jsdt/50/1/50_1/_pdf”

Funding

There are no funding for the current study.

All efforts and costs for the 2015 JRDR survey and making the ADR were totally given by the JSDT.

Availability of data and materials

  • When anyone wants to use the data and materials from the current manuscript without modifications, all data and materials are freely available, stating “the data are from the annual dialysis data report 2015 of JSDT renal data tregistry”.

  • When anyone wants 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 annual dialysis data report 2015 of JSDT renal data tregistry. 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 2015 and directed all of the 2015 JRDR survey. IM and MT 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, KT, SG, and TH had the responsibilities on the data analysis. JM had the responsibility on the ethical aspect of the JRDR survey. KN was the president of JSDT in 2015, and checked all the results from the 2015 JRDR survey and approved them to be published. All authors read and approved the final manuscript.

Ethics approval and consent to participate

  1. 1.

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

     
  2. 2.

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

     
  3. 3.

    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.

     
  4. 4.

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

     
  5. 5.

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

     

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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