overview of regular dialysis treatment in japan (as …...tap_1050 11..53 overview of regular...

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Overview of Regular Dialysis Treatment in Japan(as of 31 December 2009)

Shigeru Nakai, Kunitoshi Iseki, Noritomo Itami, Satoshi Ogata, Junichiro James Kazama,Naoki Kimata, Takashi Shigematsu, Toshio Shinoda, Tetsuo Shoji, Kazuyuki Suzuki,

Masatomo Taniguchi, Kenji Tsuchida, Hidetomo Nakamoto, Hiroshi Nishi,Seiji Hashimoto, Takeshi Hasegawa, Norio Hanafusa, Takayuki Hamano, Naohiko Fujii,Ikuto Masakane, Seiji Marubayashi, Osamu Morita, Kunihiro Yamagata, Kenji Wakai,

Atsushi Wada, Yuzo Watanabe, and Yoshiharu Tsubakihara

Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan

Abstract: A nationwide statistical survey of 4196 dialysisfacilities was conducted at the end of 2009, and 4133 facili-ties (98.5%) responded. The number of patients undergo-ing dialysis at the end of 2009 was determined to be290 661, an increase of 7240 patients (2.6%) compared withthat of 2008. The number of dialysis patients per million atthe end of 2009 was 2279.5. The crude death rate of dialysispatients from the end of 2008 to the end of 2009 was 9.6%.The mean age of the new patients introduced into dialysiswas 67.3 years old and the mean age of the entire dialysispatient population was 65.8 years old. Primary diseasessuch as diabetic nephropathy and chronic glomerulone-phritis for new dialysis patients, showed a percentage of44.5% and 21.9%, respectively. Based on the facilities sur-veyed, 84.2% of the facilities that responded to the ques-tionnaire satisfied the microbiological quality standard fordialysis fluids for the Japanese Society for Dialysis Therapy(JSDT), with an endotoxin concentration of less than

0.05 EU/mL in the dialysis fluid. Similarly, 98.2% of thefacilities surveyed satisfied another standard of the societyof a bacterial count of less than 100 cfu/mL in the dialysisfluid. The facility survey indicated that the number ofpatients who were treated by blood purification by bothperitoneal dialysis and extracorporeal circulation, such ashemodialysis, was 1720. Among the total number ofpatients, 24.8% were satisfied with the management targetrecommended in the treatment guidelines for secondaryhyperparathyroidism. These standards are set by the JSDT,based on the three parameters, i.e. serum calcium concen-tration, serum phosphorus concentration, and serum intactparathyroid hormone concentration. According to thequestionnaire, 9.8% of the patients were considered tohave a complication of dementia. Key Words: Combineduse, Peritoneal dialysis, Dementia, Dialysis, Patient popu-lation, Survey, Survival rate.

The Japanese Society for Dialysis Therapy (JSDT)has been conducting a statistical survey of dialysisfacilities across the country annually since 1968.In thissurvey, conducted at the end of 2009, new memberswere added to the District Cooperative Committee toimplement the survey, which includes a registry of

patients who undergo peritoneal dialysis (PD), i.e.the PD registry. Facilities that offer only PD wereexcluded from the previous survey but were includedas targets of this survey. The purpose of this inclusionwas to clarify the current status of PD therapy in Japanmore accurately than before.JSDT called the facilitiesthat offer only PD in advance and confirmed whetherthey had PD patients as of the end of 2009. Then,questionnaires were sent only to facilities that wereconfirmed to have PD patients as of the end of 2009.As a result, the number of facilities that participated inthe 2009 survey was 4196, an increase of 72 facilitiesfrom 2008 (4124 facilities).This increase in the numberof target facilities was the largest in the last few years.

Received October 2011.Address correspondence and reprint requests to Dr Yoshiharu

Tsubakihara, Department of Kidney Disease and Hypertension,Osaka General Medical Center, 3-1-56, Bandai-Higashi,Sumiyoshi-ku, Osaka 558-8558, Japan. Email: [email protected]

Published in J Jpn Soc Dial Ther 2011: 43(1): 1–36 (in Japanese).Reprinted with permission from the Journal of the Japanese Societyfor Dialysis Therapy.

Therapeutic Apheresis and Dialysis 2012; 16(1):11–53doi: 10.1111/j.1744-9987.2011.01050.x© 2012 The AuthorsTherapeutic Apheresis and Dialysis © 2012 International Society for Apheresis

11

The following items were newly added to the 2009survey. First, the facility and patient surveys included,for the first time, a detailed investigation of thecurrent status of patients who underwent both PDand other therapies such as hemodialysis (HD) andhemodiafiltration (HDF). As guidelines for the treat-ment of chronic kidney disease-mineral and bonedisorder (CKD-MBD), JSDT released “Clinicalpractice guideline for the management of secondaryhyperparathyroidism in chronic dialysis patients.” in2008 (1). These guidelines are currently beingrevised. The data required for this revision were alsonewly investigated in the 2009 survey. Moreover, thedialysis population is aging yearly in Japan. In linewith this background, dementia in dialysis patients isbecoming a serious problem. With the aim of obtain-ing basic data required to cope with this problem, thecurrent status of dialysis patients who have dementiaas a complication was also surveyed. In addition tothis, the activities of daily living (ADL) and place ofresidence of individual patients were surveyed again.

Similar to the 2008 survey, JSDT received candi-date research topics from its regular members, amongwhich five were selected for open recruitmentresearch projects. The verification of the database ofJSDT (database cleaning) started in 2004 and wasongoing in 2009.

In this report, we summarize data obtained fromthe 2009 survey on the following items:

A. Basic demographicsB. Current status of dialysis fluid qualityC. Current status of PD therapyD. Items associated with CKD-MBDE. Items associated with dementia

Since our previous reports, we have receivedvarious questions and critical comments about ourstatistical surveys from JSDT members. The commoncomments and frequently asked questions includethe following: (i) Is it necessary to conduct suchsurveys that require troublesome work? (ii) Thereare too many survey items. (iii) Why are the surveyitems changed every year? (iv) Disclosure of surveyitems in advance is preferable. (v) Is it effective toconduct the survey every year? The Committee ofJSDT has answered each question as much as pos-sible. Answers to these questions were given byYoshiharu Tsubakihara, Chair of the Committee, asindicated below.

Is it necessary to conduct such surveys that requiretroublesome work?

In Article 4 (Objectives and Tasks) Chapter 2 ofthe Memorandum of JSDT, it is stated that this

society shall conduct research surveys on dialysistherapies, that is, blood purification therapies (e.g.HD, PD, hemofiltration, hemoadsorption, and plasmaexchange) and the causes and clinical conditions ofdiseases treated by dialysis. Research on dialysistherapies will be promoted and information will bedisseminated through the presentation of surveyresults, exchange of findings, and provision of infor-mation, thereby contributing to academic progress ofdialysis therapy in Japan. Therefore, the implementa-tion of statistical surveys is one objective of JSDTand one of the most important tasks. We conductstatistical surveys not because it is stated that suchsurveys shall be conducted in the Memorandum butbecause we believe that they are important. Weconsider that the discontinuation of our statisticalsurveys will lead to the loss of the direction of dialysiscare in Japan.

There are too many survey itemsThis is related to question (iii). The items of our

surveys are selected annually to satisfy variousrequirements, such as acquiring necessary informa-tion for the preparation of guidelines. As shown inpaper questionnaires, the number of survey items is,in principle, limited so that they fit within one page.We make every effort to not increase the totalnumber of survey items.

Why are the survey items changed every year?The needs for survey items are changing every

year. Survey items are determined in accordance withthe changing needs. The number of items is appro-priately controlled so that it does not continue toincrease.

Disclosure of survey items in advance is preferableIt is very difficult to determine the survey items

2 years before the survey. To inform dialysis facilitiesabout the determined survey items as early as pos-sible, information on survey items is published in thejournals published by JSDT in October, and it is alsosent by fax to individual facilities.

Is it effective to conduct the survey every year?We believe that our annual statistical survey is of

great significance. For example, when this regularsurvey is carried out every other year, the motivationof surveyed facilities to respond to the questionnairesmay decrease and lead to a decrease in the collectionrate. We believe that this survey has a high collectionrate because it is carried out annually.

However, we also recognize that complaints aboutthis survey from the society members may come from

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© 2012 The AuthorsTherapeutic Apheresis and Dialysis © 2012 International Society for ApheresisTher Apher Dial, Vol. 16, No. 1, 2012

insufficient feedback of the survey and analysisresults to the members who cooperated in this survey.To deal with this problem, we publish, on the JSDThomepage, this annual rapid report of survey results,i.e.“The Illustrated, Current Status of Chronic Dialy-sis in Japan,” (reports since 2002 are available). Indi-vidual facilities are provided with only one printedcopy. Moreover, we are devoting ourselves to thepreparation of a CD-ROM that contains detaileddata, which every member can use to search neces-sary information. We have received many proposalsfor open recruitment research projects started2 years before. The results of accepted open recruit-ment research projects and research carried out bythe Committee have been presented and appreciatedat many conferences in Japan as well as the US andEuropean countries. In addition, findings of thissurvey are used as the basis for the preparation ofguidelines and contribute to the improvement ofdialysis care in Japan.

PATIENTS AND METHODS

This survey is conducted every year by sendingquestionnaires to target dialysis facilities. A total of4196 facilities surveyed were either member facilitiesof JSDT, nonmember facilities offering chronic HD,or facilities offering PD but not HD as of 31 Decem-ber 2009.The number of facilities participating in thissurvey increased by 72 (1.7%) from the previousyear.

The questionnaires were mainly sent and collectedby postal mail; some were also faxed. Paper question-naires and electronic media, i.e. universal serial bus(USB) memory drives, were sent to all the 4196 targetfacilities, 3352 of which responded using the USBmemory drives.

In this survey, we used two sets of questionnaires.One was about the facilities (facility survey), in whichitems related to the details of dialysis facilities wereinvestigated, such as the number of patients, thenumber of staff members, and the number of patientstations at individual facilities (using the question-naire referred to as “Sheet I”). The other survey wasabout the patients (patient survey), in which the epi-demiological background, treatment conditions, andoutcome of treatment of individual dialysis patientswere examined (using the questionnaires referred toas “Sheets II, III, and IV”).

The collection rate of the questionnaire (Sheet I)in the 2009 survey was 98.5% (4133 facilities), whichexceeded the goal of at least 98%. Moreover, thecollection rate of both questionnaires, i.e. the facility

and patient surveys, from facilities was 96.0% (4029facilities), which also exceeded the goal of at least95%.

As mentioned above, the number of facilities thatresponded using electronic media was 3352 (81.1%),a continued increase from that of the 2008 survey(79.5%). This increase in the number of facilities thatresponded using electronic media contributes to theaccurate and simple analysis of survey data.

The cumulative survival rates after introductioninto dialysis were calculated using the mortality tablemethod (2).

Additional survey itemsIn the 2009 survey, the following items were added

to the facility survey.

• Number of bedside consoles equipped with endot-oxin retentive filter (ETRF)

• Use or nonuse of ETRF for collecting dialysis fluid• Site from which dialysis fluid was sampled for the

dialysis fluid test• Frequency of measurement of endotoxin concen-

tration in dialysis fluid• Endotoxin concentration in dialysis fluid• Frequency of measurement of bacterial count in

dialysis fluid• Volume of sample for measurement of bacterial

count in dialysis fluid• Medium used for cultivation of bacteria in dialysis

fluid• Bacterial count in dialysis fluid• Number of patients who did not undergo PD

despite having a peritoneal catheter for PD(including those who underwent only peritonealcleaning) among those who underwent daytimedialysis, nighttime dialysis, or home HD

• Number of patients who underwent both PD andother blood purification therapies using extracor-poreal circulation such as HD and HDF

• Number of new patients who were started on PDwithin the survey period but introduced to otherblood purification therapies within the sameperiod

In the patient survey, the following items wereinvestigated in addition to the basic survey items,such as, epidemiological background and patientoutcomes.

• Current status of combined use of PD and otherblood purification therapies using extracorporealcirculation such as HD and HDF

• Number of years on PD (PD period) (for patientswho were receiving PD at the time of survey)

Chronic Dialysis Treatment in Japan 2009 13

© 2012 The AuthorsTherapeutic Apheresis and Dialysis © 2012 International Society for Apheresis Ther Apher Dial, Vol. 16, No. 1, 2012

• Number of times of undergoing blood purificationtherapy per week (frequency of dialysis per week)

• Duration of one session of blood purification usingextracorporeal circulation (dialysis duration)

• Calcium level in dialysis fluid• Body height• Predialysis and postdialysis weights• Predialysis and postdialysis blood urea nitrogen

(BUN) levels• Predialysis and postdialysis serum creatinine levels• Predialysis serum calcium level• Predialysis serum phosphorus level• Predialysis serum magnesium level• Predialysis serum albumin level• Predialysis serum C-reactive protein (CRP) level• Predialysis blood hemoglobin level• Predialysis serum alkaline phosphatase (ALP)

level• Measurement method for serum parathyroid

hormone (PTH) level• Serum PTH level• Administration or nonadministration of sevelamer

hydrochloride (HCl) drug• Administration or nonadministration of calcium

carbonate drug• Administration or nonadministration of lantha-

num carbonate drug• Administration or nonadministration of other

phosphate binders• Administration or nonadministration of oral

vitamin D supplements• Administration or nonadministration of intra-

venous vitamin D supplements• Administration or nonadministration of cinacalcet• History of undergoing parathyroidectomy (PTx)• History of undergoing percutaneous ethanol injec-

tion therapy (PEIT)• Complications of dementia• Activities of daily living (ADL)• Place of residence• History of myocardial infarction• History of cerebral hemorrhage• History of cerebral infarction• History of amputation• History of hip fracture

RESULTS AND DISCUSSION

Basic demographics

Number of patientsTable 1 shows a summary of the dynamics of the

dialysis patient population in Japan at the end of 2009obtained in this survey. Data on the number of years

on dialysis (dialysis period) and the longest period ondialysis were obtained from the patient survey. Allthe other results were obtained from the facilitysurvey.

The total number of dialysis patients in Japan atthe end of 2009 was 290 661, as determined from thefacility survey. The number of dialysis patients inJapan at the end of 2008 was 283 421, an increase of7240 patients (2.6%) from the end of 2008 to the endof 2009.

The number of facilities that responded to thequestionnaire at the end of 2009 was 4133, anincrease of 52 (1.3%) from the previous year.The number of bedside consoles at the end of 2009was 114 979, an increase of 2981 (2.7%) from theprevious year. The total number of patients forwhom dialysis can be simultaneously provided at allthe facilities was 113 487 and the maximum dialysiscapacity was 383 530 patients, both of whichincreased in 2009.

The percentage of patients who underwent day-time dialysis increased slightly to 82.2%, whereaspatients who underwent nighttime dialysis decreasedfurther to 14.4%.The trends of increasing percentageof daytime dialysis patients and decreasing percent-age of nighttime dialysis patients were continuouslyobserved over the last 10 years. The number ofpatients who underwent home HD was 236, anincrease of 43 (22.3%) from the previous year, but itwas still a small number of patients.

As described above, the current status of patientswho underwent both PD and other therapies such asHD and HDF was newly investigated in the presentsurvey. According to the results of the facility survey,the number of patients who underwent both PD andother therapies such as HD and HDF in Japan atthe end of 2009 was 1720 (0.6% of all the dialysispatients).

According to the patient survey, the longest periodon dialysis was 41 years and 8 months. The numberof dialysis patients per million at the end of 2009was 2279.5. Table 2 shows changes in the numberof dialysis patients per million. Table 3 shows thetotal number of chronic dialysis patients in eachprefecture of Japan determined from the facilitysurvey.

Mean ageThe dialysis patient population in Japan is aging

yearly. Table 4 shows changes in mean age ofpatients obtained from the patient survey. As shownin this table, the mean age of new patients who werestarted on dialysis in 2009 was 67.3 years (�13.3,�SD here and hereafter) and the mean age of all

S Nakai et al.14


the dialysis patients in 2009 was 65.8 years (�12.6).The dialysis patient population aged by 6.8 yearsfrom the end of 1989 to the end of 1999 and by5.2 years from the end of 1999 to the end of 2009.Thus, the rate of aging of the dialysis patient popu-lation decreased. Similarly, the mean age of new

patients who were started on dialysis increased by6.0 years from the end of 1989 to the end of 1999,but by only 3.9 years from the end of 1999 to theend of 2009. These findings show that the rate ofaging of new patients who were started on dialysisalso decreased.

TABLE 1. Current status of chronic dialysis therapy in Japan (as of 31 December 2009)

Number of facilities 4 133 Increase of 52 (1.3%)

Equipment Number of patient station 114 979 Increase of 2 981 (2.7%)Capacity Simultaneous dialysis

(people)113 487 Increase of 2 889 (2.6%)

Maximum accommodationcapacity (people)

383 530 Increase of 8 748 (2.3%)

Chronic dialysis patients† 290 661 Increase of 7 240 (2.6%)

Daytime dialysis 238 848 (82.2%)Nighttime dialysis 41 719 (14.4%)Home dialysis 236 (0.1%)Peritoneal dialysis 9 858 (3.4%)

Number of patients who underwent PD with HD, HDF, etc. 1 720 (0.6%)Patients per million 2 279.5 Increase of 59.9 (2.7%)Number of patients newly introduced to dialysis 37 566 Decrease of 614 (1.6%)Number of decreased patients 27 646 Increase of 380 (1.4%)(The above data were obtained from the facility survey.)Duration of dialysis‡ Male Female Unknown Total0 � < 5 88 603 48 331 0 136 934 (48.6%)5 � < 10 43 915 27 336 0 71 251 (25.3%)10 � < 15 20 642 14 432 0 35 074 (12.4%)15 � < 20 10 098 8 013 0 18 111 (6.4%)20 � < 25 5 339 4 537 0 9 876 (3.5%)25� 5 899 4 851 0 10 750 (3.8%)

Total 174 496 107 500 0 281 996 (100.0%)Longest dialysis history 41 years and 8 months

†The total number of chronic dialysis patients is the total of the column for the number of patients in sheet I, and does not necessarily agreewith the total number of patients counted according to the method of treatment. ‡The number of dialysis patients was calculated fromquestionnaire sheets II to IV.

TABLE 2. Changes in number of dialysis patients per million

YearNumber of patients per

million YearNumber of patients per

million

1983 443.7 1997 1394.91984 497.5 1998 1472.51985 547.8 1999 1556.71986 604.4 2000 1624.11987 658.8 2001 1721.91988 721.1 2002 1801.21989† 790.0 2003 1862.71990 835.7 2004 1943.51991 937.6 2005 2017.61992 995.8 2006 2069.91993 1076.4 2007 2154.21994 1149.4 2008 2219.61995 1229.7 2009 2279.51996 1328.4

Tabulated results of facility survey. †1989: The collection rate was 86% and the obtaineddata were rounded off to the second decimal place.



Tables 5,6 show the gender and age distributionsof new patients who were started on dialysis and alldialysis patients in 2009, respectively. Tables 7,8show the summaries of the primary diseasesof new patients who were started on dialysis andthe dialysis patients in 2009, respectively. The datain these tables were obtained from the patientsurvey.

Primary disease of new patients who were startedon dialysis

Table 7 shows a summary of the primary diseasesof new patients who were started on dialysis in 2009.Table 8 shows a summary of the primary diseases ofall dialysis patients at the end of 2009.

Table 9 shows changes in the percentage of newpatients who were started on dialysis each year with

TABLE 3. Numbers of chronic dialysis patients in prefectures

Names of administrativedivisions Daytime Nighttime

Homehemodialysis

Peritonealdialysis Total†

Hokkaido 12 352 1 347 14 521 14 234Aomori prefecture 2 820 254 0 102 3 176Iwate prefecture 2 411 331 0 132 2 874Miyagi prefecture 3 801 872 0 72 4 745Akita prefecture 1 623 150 0 68 1 841Yamagata prefecture 1 967 257 2 132 2 358Fukushima prefecture 4 011 471 0 216 4 698Ibaraki prefecture 5 793 875 1 154 6 823Tochigi prefecture 4 528 742 2 52 5 324Gunma prefecture 4 229 756 0 92 5 077Saitama prefecture 12 170 1 866 41 391 14 468Chiba prefecture 10 352 1 813 1 276 12 442Tokyo 22 199 4 981 6 1011 28 197Kanagawa prefecture 13 786 3 091 20 520 17 417Niigata prefecture 3 563 1 004 1 160 4 728Toyama prefecture 1 913 263 1 79 2 256Ishikawa prefecture 1 999 327 0 93 2 419Fukui prefecture 1 502 173 0 80 1 755Yamanashi prefecture 1 864 201 1 60 2 126Nagano prefecture 3 685 736 1 133 4 555Gifu prefecture 3 389 636 5 141 4 171Shizuoka prefecture 7 614 1 381 4 262 9 261Aichi prefecture 12 075 3 169 33 623 15 900Mie prefecture 3 169 610 3 125 3 907Shiga prefecture 2 106 420 13 119 2 658Kyoto prefecture 4 531 1 047 2 255 5 835Osaka prefecture 17 399 2 875 39 664 20 977Hyogo prefecture 9 961 1 664 17 304 11 946Nara prefecture 2 728 234 5 100 3 067Wakayama prefecture 2 435 260 1 31 2 727Tottori prefecture 1 098 128 0 94 1 320Shimane prefecture 1 170 147 0 97 1 414Okayama prefecture 3 606 467 0 261 4 334Hiroshima prefecture 5 892 557 5 488 6 942Yamaguchi prefecture 2 793 363 0 151 3 307Tokushima prefecture 2 065 275 0 177 2 517Kagawa prefecture 2 063 160 6 241 2 470Ehime prefecture 2 833 420 1 150 3 404Kochi prefecture 1 892 236 0 41 2 169Fukuoka prefecture 10 189 2 377 4 521 13 091Saga prefecture 1 758 271 1 14 2 044Nagasaki prefecture 3 072 459 3 163 3 697Kumamoto prefecture 4 700 982 0 141 5 823Oita prefecture 3 204 338 1 135 3 678Miyazaki prefecture 3 007 539 0 46 3 592Kagoshima prefecture 4 189 608 2 98 4 897Okinawa prefecture 3 342 586 0 72 4 000Total 238 848 41 719 236 9858 290 661

The number of dialysis patients was calculated based on facility survey data. †The total number of chronic dialysis patients is the total inthe column for the number of patients in sheet I, and does not necessarily agree with the total number of patients counted in accordance withthe method of dialysis.

S Nakai et al.16


TABLE 4. Changes in mean ages of new patients started on dialysis and of patients at the end of each year

Age of patients newlyintroduced into dialysis treatment (years)

Age of patients at the endof each year (years)

Year Mean �SD Mean �SD1983 51.9 15.5 48.3 13.81984 53.2 15.3 49.2 13.81985 54.4 15.4 50.3 13.71986 55.1 15.2 51.1 13.61987 55.9 14.9 52.1 13.71988 56.9 14.9 52.9 13.61989 57.4 14.7 53.8 13.51990 58.1 14.6 54.5 13.51991 58.1 14.6 55.3 13.51992 59.5 14.5 56.0 13.51993 59.8 14.4 56.6 13.51994 60.4 14.3 57.3 13.51995 61.0 14.2 58.0 13.41996 61.5 14.2 58.6 13.41997 62.2 14.0 59.2 13.41998 62.7 13.9 59.9 13.31999 63.4 13.9 60.6 13.32000 63.8 13.9 61.2 13.22001 64.2 13.7 61.6 13.12002 64.7 13.6 62.2 13.02003 65.4 13.5 62.8 12.92004 65.8 13.4 63.3 12.92005 66.2 13.4 63.9 12.82006 66.4 13.4 64.4 12.82007 66.8 13.3 64.9 12.72008 67.2 13.3 65.3 12.72009 67.3 13.3 65.8 12.6

TABLE 5. Number of new patients started on dialysis in 2009 for different ages and both genders

Age of the patients whennewly introduced intodialysis (years) Male (%)† Female (%)† Subtotal (%)†

No informationavailable Total (%)†

<5 8 (0.0) 9 (0.1) 17 (0.0) 17 (0.0)5–9 6 (0.0) 0 (0.0) 6 (0.0) 6 (0.0)10–14 7 (0.0) 4 (0.0) 11 (0.0) 11 (0.0)15–19 24 (0.1) 18 (0.1) 42 (0.1) 42 (0.1)20–24 53 (0.2) 23 (0.2) 76 (0.2) 76 (0.2)25–29 103 (0.4) 52 (0.4) 155 (0.4) 155 (0.4)30–34 249 (1.0) 114 (0.9) 363 (1.0) 363 (1.0)35–39 493 (2.0) 227 (1.8) 720 (1.9) 720 (1.9)40–44 683 (2.8) 300 (2.3) 983 (2.6) 983 (2.6)45–49 1 028 (4.2) 409 (3.2) 1 437 (3.9) 1 437 (3.9)50–54 1 426 (5.9) 601 (4.7) 2 027 (5.5) 2 027 (5.5)55–59 2 423 (9.9) 1 032 (8.1) 3 455 (9.3) 3 455 (9.3)60–64 3 254 (13.4) 1 384 (10.8) 4 638 (12.5) 4 638 (12.5)65–69 3 600 (14.8) 1 627 (12.7) 5 227 (14.1) 5 227 (14.1)70–74 3 656 (15.0) 1 883 (14.7) 5 539 (14.9) 5 539 (14.9)75–79 3 639 (14.9) 2 048 (16.0) 5 687 (15.3) 5 687 (15.3)80–84 2 565 (10.5) 1 766 (13.8) 4 331 (11.6) 4 331 (11.6)85–89 943 (3.9) 1 022 (8.0) 1 965 (5.3) 1 965 (5.3)90–94 185 (0.8) 250 (2.0) 435 (1.2) 435 (1.2)95� 23 (0.1) 46 (0.4) 69 (0.2) 69 (0.2)

Total 24 368 (100.0) 12 815 (100.0) 37 183 (100.0) 37 183 (100.0)No information available 65 39 104 104

Total 24 433 12 854 37 287 37 287Mean 66.37 69.08 67.31 67.31SD 13.04 13.61 13.30 13.30

†The values in parentheses on the right side of each figure represent the percentage relative to the total in each column.



various primary causes of renal failure (primary dis-eases). The percentage of patients with diabeticnephropathy as the primary disease among the newpatients who were started on dialysis continuedto increase and reached 44.5% in 2009. The percent-age of patients with chronic glomerulonephritis,which is currently the second most common primarydisease, has declined annually as has the absolutenumber of such patients. The percentage of patientswith “unspecified” primary diseases was the thirdhighest (10.7%). In relation to the aging of newdialysis patients, the percentage of patients withnephrosclerosis continued to increase and reached10.7%. The percentages of patients with polycystickidney disease, rapidly progressive glomerul-onephritis, systemic lupus erythematosus (SLE)nephritis, and chronic pyelonephritis as theprimary diseases were nearly the same as in previousyears

Table 10 shows changes in the percentages of alldialysis patients at the end of each year with variousprimary diseases. Among all dialysis patients, chronicglomerulonephritis was still the most commonprimary disease. However, there was a clear decreasein the percentage of patients with this primarydisease. In contrast, the percentage of patients withdiabetic nephropathy among all dialysis patients con-

tinuously increased. The percentages of patients withchronic glomerulonephritis and diabetic nephropa-thy at the end of 2009 were 37.6 and 35.1%, respec-tively, a difference of 2.5 points. If the above trendscontinue, diabetic nephropathy will become the mostcommon primary disease among all dialysis patientsin a few years, similar to the trend among new dialysispatients. The primary diseases with the third andfourth highest percentages of patients among alldialysis patients in 2009 were unspecified primarydiseases (7.7%) and nephrosclerosis (7.1%), respec-tively. The percentage of patients with nephrosclero-sis among all dialysis patients was also increasing.The percentages of patients with polycystic kidneydisease, chronic pyelonephritis, SLE nephritis, andrapidly progressive glomerulonephritis as the pri-mary diseases were nearly the same as those in pre-vious years.

Causes of deathTable 11 shows the classification of the causes of

death of new patients who were started on dialysis in2009 and who died by the end of 2009. Table 12 showsthe classification of the causes of death of all thedialysis patients who died in 2009. Table 13 showschanges in the percentages of the leading causes ofdeath in all dialysis patients. Since the 2003 survey,

TABLE 6. Number of all dialysis patients in 2009 for different ages and both genders

Age (years) Male (%)† Female (%)† Subtotal (%)†No information

available Total (%)†

<5 24 (0.0) 21 (0.0) 45 (0.0) 45 (0.0)5–9 16 (0.0) 15 (0.0) 31 (0.0) 31 (0.0)10–14 22 (0.0) 10 (0.0) 32 (0.0) 32 (0.0)15–19 62 (0.0) 45 (0.0) 107 (0.0) 107 (0.0)20–24 246 (0.1) 126 (0.1) 372 (0.1) 372 (0.1)25–29 626 (0.4) 348 (0.3) 974 (0.3) 974 (0.3)30–34 1 620 (0.9) 822 (0.8) 2 442 (0.9) 2 442 (0.9)35–39 3 513 (2.0) 1 732 (1.6) 5 245 (1.9) 5 245 (1.9)40–44 5 684 (3.3) 2 791 (2.6) 8 475 (3.0) 8 475 (3.0)45–49 8 090 (4.6) 4 125 (3.8) 12 215 (4.3) 12 215 (4.3)50–54 11 869 (6.8) 6 448 (6.0) 18 317 (6.5) 18 317 (6.5)55–59 20 209 (11.6) 11 348 (10.6) 31 557 (11.2) 31 557 (11.2)60–64 27 690 (15.9) 15 292 (14.2) 42 982 (15.2) 42 982 (15.2)65–69 27 776 (15.9) 16 156 (15.0) 43 932 (15.6) 43 932 (15.6)70–74 25 503 (14.6) 15 670 (14.6) 41 173 (14.6) 41 173 (14.6)75–79 21 589 (12.4) 14 016 (13.0) 35 605 (12.6) 35 605 (12.6)80–84 13 482 (7.7) 10 865 (10.1) 24 347 (8.6) 24 347 (8.6)85–89 5 063 (2.9) 5 764 (5.4) 10 827 (3.8) 10 827 (3.8)90–94 1 237 (0.7) 1 620 (1.5) 2 857 (1.0) 2 857 (1.0)95� 167 (0.1) 277 (0.3) 444 (0.2) 444 (0.2)

Total 174 488 (100.0) 107 491 (100.0) 281 979 (100.0) 281 979 (100.0)No information

available8 9 17 17

Total 174 496 107 500 281 996 281 996Mean 65.00 67.00 65.76 65.76SD 12.45 12.83 12.63 12.63

†The values in parentheses on the right side of each figure represent the percentage relative to the total in each column.

S Nakai et al.18


the classification of the causes of death was changedto the tenth revision of the International StatisticalClassification of Diseases and Related Health Pro-blems (ICD-10).

Similar to the results in 2008, the leading cause ofdeath of new patients who were started on dialysis in2009 was infectious diseases (26.1%). The second,third, fourth, and fifth leading causes were cardiacfailure (21.8%), malignant tumors (10.4%), cere-brovascular disease (5.4%), and cardiac infarction(5.4%), respectively. The trend of increasing percent-age of patients who died of infectious diseases wascontinuously observed in the last 20 years. In contrast,the percentage of patients who died of cardiac failurehas gradually decreased. The percentage of patientswho died of malignant tumors has remained steady atapproximately 10% in recent years. The yearly per-centages of patients who died of cerebrovascular

disease and cardiac infarction decreased over the last10 years.

Among all dialysis patients, the leading cause ofdeath was cardiac failure; the percentage of patientswho died of cardiac failure was 23.6% in 2009. Thepercentage of patients who died of cardiac failureamong all dialysis patients markedly decreased in the1990s and remained at nearly 23–26% thereafter.Thepercentage of patients who died of infectious diseasesamong all dialysis patients was 20.7% in 2009 and hastended to gradually increase in the last 20 years. Incontrast, the percentage of patients who died of cere-brovascular disease steadily decreased and reached8.4% in 2009. The percentage of patients who died ofcardiac infarction also gradually decreased from thepeak of 8.4% in 1997 to 4.0% in 2009.The percentageof patients who died of malignant tumors tended toincrease slightly and reached 9.4% in 2009.

TABLE 7. Number of new patients started on dialysis in 2009 for different primary diseases and their mean age

Primary diseaseNumber of

patients (%)No information on

birth date (%) Total (%) Mean age SD

Chronicglomerulonephritis

8 117 (21.9) 38 (36.5) 8 155 (21.9) 66.91 14.52

Chronic pyelonephritis 261 (0.7) 1 (1.0) 262 (0.7) 67.85 13.93Rapidly progressive

glomerulonephritis456 (1.2) 2 (1.9) 458 (1.2) 70.42 13.00

Nephropathy ofpregnancy/pregnancytoxemia

45 (0.1) 0 (0.0) 45 (0.1) 59.51 13.47

Other nephritides thatcannot be classified

172 (0.5) 1 (1.0) 173 (0.5) 64.60 17.89

Polycystic kidney 847 (2.3) 5 (4.8) 852 (2.3) 61.46 12.38Nephrosclerosis 3 970 (10.7) 9 (8.7) 3 979 (10.7) 74.06 11.33Malignant hypertension 287 (0.8) 2 (1.9) 289 (0.8) 63.75 16.85Diabetic nephropathy 16 524 (44.5) 25 (24.0) 16 549 (44.5) 65.66 11.65SLE nephritis 272 (0.7) 0 (0.0) 272 (0.7) 60.43 15.90Amyloidal kidney 144 (0.4) 0 (0.0) 144 (0.4) 66.90 11.76Gouty kidney 86 (0.2) 0 (0.0) 86 (0.2) 64.53 12.84Renal failure due to

congenital abnormalityof metabolism

25 (0.1) 0 (0.0) 25 (0.1) 46.32 20.60

Kidney and urinary tracttuberculosis

14 (0.0) 0 (0.0) 14 (0.0) 69.36 10.42

Kidney and urinary tractstone

62 (0.2) 0 (0.0) 62 (0.2) 69.68 10.74

Kidney and urinary tracttumor

156 (0.4) 1 (1.0) 157 (0.4) 70.90 12.51

Obstructive urinary tractdisease

96 (0.3) 0 (0.0) 96 (0.3) 64.89 18.06

Myeloma 140 (0.4) 0 (0.0) 140 (0.4) 71.21 10.19Hypoplastic kidney 52 (0.1) 2 (1.9) 54 (0.1) 39.73 28.15Undetermined 3 963 (10.7) 13 (12.5) 3 976 (10.7) 70.89 13.20Reintroduction after

transplantation199 (0.5) 1 (1.0) 200 (0.5) 54.65 16.22

Others 1 223 (3.3) 4 (3.8) 1 227 (3.3) 67.34 15.95

Total 37 111 (100.0) 104 (100.0) 37 215 (100.0) 67.30 13.31No information available 72 72 70.92 11.31

Total 37 183 104 37 287 67.31 13.30

The values in parentheses under each figure represent the percentage relative to the total in each column. The column “No informationon birth date” shows the number of patients who provided no date of birth, such that the calculation of age was impossible. SLE, systemiclupus erythematosus.



Annual crude death rateThe annual crude death rate was calculated from

the facility survey data. It shows the percentage ofpatients who died in a given year with respect to themean annual number of dialysis patients. The annualcrude death rate in 2009 was 9.6%. Table 14 showsthe trend of annual crude death rates since 1983. Itis expected that the annual crude death rate willincrease because of the increase in the number ofpatients with a poor prognosis, such as older patientswho were started on dialysis and patients with dia-betic nephropathy and nephrosclerosis. However, theannual crude death rate has remained at approxi-mately 9.5% since 1992.

Cumulative survival rate of new patients who werestarted on dialysis for each year

The cumulative survival rates of new patients whowere started on dialysis from 1983 are summarized by

year of introduction (Table 15). Moreover, the 1-, 5-,10-, 15-, 20-, and 25-year survival rates of patientswho were started on dialysis were extracted from thetable and plotted in Figure 1.

The 1–10-year survival rates have been increasingsince 1992 for patients who were started on dialysis in1992 or later. This trend may be due to the improve-ment of anemia therapy using erythropoietin startingat the initial phase of dialysis because the clinical useof genetically modified erythropoietin started aroundthis time.

Current status of dialysis fluid qualitySince 2006, the current status of bacteriological

quality of dialysis fluid has been investigated in thefacility survey. In the microbiological quality stan-dard for dialysis fluids (3) established in 2008 by theCommittee of Scientific Academy of JSDT, the unit

TABLE 8. Number of all dialysis patients in 2009 for different primary diseases and their mean age

Primary diseaseNumber of

patients (%)No information on

birth date (%) Total (%) Mean age SD

Chronic glomerulonephritis 106 000 (37.6) 2 (11.8) 106 002 (37.6) 64.51 12.75Chronic pyelonephritis 3 069 (1.1) 0 (0.0) 3 069 (1.1) 63.74 14.23Rapidly progressive

glomerulonephritis1 961 (0.7) 0 (0.0) 1 961 (0.7) 66.20 13.85

Nephropathy ofpregnancy/pregnancytoxemia

1 755 (0.6) 0 (0.0) 1 755 (0.6) 61.10 9.87

Other nephritides that cannotbe classified

1 315 (0.5) 0 (0.0) 1 315 (0.5) 59.29 16.98

Polycystic kidney 9 482 (3.4) 0 (0.0) 9 482 (3.4) 63.54 11.03Nephrosclerosis 20 131 (7.1) 3 (17.6) 20 134 (7.1) 73.27 11.88Malignant hypertension 2 177 (0.8) 1 (5.9) 2 178 (0.8) 63.19 14.61Diabetic nephropathy 99 032 (35.1) 8 (47.1) 99 040 (35.1) 66.24 11.03SLE nephritis 2 340 (0.8) 0 (0.0) 2 340 (0.8) 58.26 13.75Amyloidal kidney 516 (0.2) 0 (0.0) 516 (0.2) 65.97 11.24Gouty kidney 1 251 (0.4) 0 (0.0) 1 251 (0.4) 66.37 11.69Renal failure due to

congenital abnormality ofmetabolism

263 (0.1) 0 (0.0) 263 (0.1) 48.68 16.89

Kidney and urinary tracttuberculosis

330 (0.1) 0 (0.0) 330 (0.1) 70.52 9.42

Kidney and urinary tract stone 568 (0.2) 0 (0.0) 568 (0.2) 69.29 11.41Kidney and urinary tract

tumor727 (0.3) 1 (5.9) 728 (0.3) 70.38 11.89

Obstructive urinary tractdisease

692 (0.2) 0 (0.0) 692 (0.2) 60.90 18.22

Myeloma 207 (0.1) 0 (0.0) 207 (0.1) 70.34 10.95Hypoplastic kidney 585 (0.2) 0 (0.0) 585 (0.2) 41.30 19.66Undetermined 21 824 (7.7) 2 (11.8) 21 826 (7.7) 68.10 13.39Reintroduction after

transplantation2 048 (0.7) 0 (0.0) 2 048 (0.7) 54.22 12.76

Others 5 623 (2.0) 0 (0.0) 5 623 (2.0) 63.50 16.16

Total 281 896 (100.0) 17 (100.0) 281 913 (100.0) 65.76 12.63No information available 83 83 68.47 12.16

Total 281 979 17 281 996 65.76 12.63

The values in parentheses under each figure represent the percentage relative to the total in each column. The column “No informationon birth date” shows the number of patients who provided no date of birth, such that the calculation of age was impossible. SLE, systemiclupus erythematosus.

S Nakai et al.20


TAB

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of endotoxin concentration was changed from EU/Lto EU/mL in accordance with ISO standards fordialysis related therapy. The survey at the endof 2008 also followed this standard, then the unitof endotoxin concentration was changed fromEU/L to EU/mL. In the 2008 survey, however, manywrong values possibly resulting from misunder-standing of the unit of endotoxin concentration

were found. Therefore, the tabulated results onendotoxin concentration in the dialysis fluidwere not included in the 2008 report (4). In the 2009report, however, the tabulated results on endotoxinconcentration in the dialysis fluid were providedbecause the change in the unit of endotoxinconcentration was expected to be widely knownalready.

TABLE 11. Classification of causes of death of new patients who were started on dialysis and died in 2009

Cause of death Male (%) Female (%) Total (%) No information available Total (%)

Cardiac failure 413 (20.8) 254 (23.5) 667 (21.8) 0 667 (21.8)Cerebrovascular disease 105 (5.3) 60 (5.5) 165 (5.4) 0 165 (5.4)Infectious disease 535 (27.0) 266 (24.6) 801 (26.1) 0 801 (26.1)Hemorrhage 44 (2.2) 30 (2.8) 74 (2.4) 0 74 (2.4)Malignant tumor 219 (11.0) 101 (9.3) 320 (10.4) 0 320 (10.4)Cachexia/Uremia 57 (2.9) 31 (2.9) 88 (2.9) 0 88 (2.9)Cardiac infarction 71 (3.6) 36 (3.3) 107 (3.5) 0 107 (3.5)Potassium

poisoning/Moribund57 (2.9) 30 (2.8) 87 (2.8) 0 87 (2.8)

Chronic hepatitis/Cirrhosis 41 (2.1) 16 (1.5) 57 (1.9) 0 57 (1.9)Encephalopathy 6 (0.3) 3 (0.3) 9 (0.3) 0 9 (0.3)Suicide/Refusal of

treatment24 (1.2) 11 (1.0) 35 (1.1) 0 35 (1.1)

Intestinal obstruction 22 (1.1) 7 (0.6) 29 (0.9) 0 29 (0.9)Lung thrombus/Pulmonary

embolus7 (0.4) 4 (0.4) 11 (0.4) 0 11 (0.4)

Death due to disaster 7 (0.4) 4 (0.4) 11 (0.4) 0 11 (0.4)Others 220 (11.1) 119 (11.0) 339 (11.1) 0 339 (11.1)Undetermined 154 (7.8) 110 (10.2) 264 (8.6) 0 264 (8.6)

Total 1982 (100.0) 1082 (100.0) 3064 (100.0) 0 3064 (100.0)No information available 7 3 10 10

Total 1989 1085 3074 0 3074

The values in parentheses under each figure represent the percentage relative to the total in each column.

TABLE 12. Classification of causes of death of patients who died in 2009

Cause of death Male (%) Female (%) Total (%) No information available Total (%)

Cardiac failure 3 639 (22.1) 2447 (26.4) 6 086 (23.6) 0 6 086 (23.6)Cerebrovascular disease 1 348 (8.2) 812 (8.8) 2 160 (8.4) 0 2 160 (8.4)Infectious disease 3 476 (21.1) 1859 (20.1) 5 335 (20.7) 0 5 335 (20.7)Hemorrhage 296 (1.8) 195 (2.1) 491 (1.9) 0 491 (1.9)Malignant tumor 1 761 (10.7) 650 (7.0) 2 411 (9.4) 0 2 411 (9.4)Cachexia/Uremia 428 (2.6) 264 (2.9) 692 (2.7) 0 692 (2.7)Cardiac infarction 717 (4.3) 324 (3.5) 1 041 (4.0) 0 1 041 (4.0)Potassium

poisoning/Moribund774 (4.7) 413 (4.5) 1 187 (4.6) 0 1 187 (4.6)

Chronic hepatitis/Cirrhosis 218 (1.3) 82 (0.9) 300 (1.2) 0 300 (1.2)Encephalopathy 23 (0.1) 9 (0.1) 32 (0.1) 0 32 (0.1)Suicide/Refusal of

treatment171 (1.0) 69 (0.7) 240 (0.9) 0 240 (0.9)

Intestinal obstruction 138 (0.8) 101 (1.1) 239 (0.9) 0 239 (0.9)Lung thrombus/Pulmonary

embolus45 (0.3) 21 (0.2) 66 (0.3) 0 66 (0.3)

Death due to disaster 117 (0.7) 41 (0.4) 158 (0.6) 0 158 (0.6)Others 1 534 (9.3) 1050 (11.3) 2 584 (10.0) 0 2 584 (10.0)Undetermined 1 799 (10.9) 921 (9.9) 2 720 (10.6) 0 2 720 (10.6)

Total 16 484 (100.0) 9258 (100.0) 25 742 (100.0) 0 25 742 (100.0)No information available 46 25 71 0 71

Total 16 530 9283 25 813 0 25 813

The values in parentheses under each figure represent the percentage relative to the total in each column.

S Nakai et al.22


Frequency of measurement of endotoxinconcentration in dialysis fluid (Table 16)

There were 3809 facilities that responded to ques-tions regarding the frequency of measurement ofendotoxin concentration in the dialysis fluid. Table 16shows a summary of the frequencies of measurementof endotoxin concentration in the dialysis fluid indifferent medical organizations. The measurement ofendotoxin concentration in the dialysis fluid in alltypes of medical organization was moderately morefrequent than in the previous year (4). Namely, in2009, the endotoxin concentration in the dialysis fluidwas measured at least once a year in 89.2% of thefacilities that responded to the questionnaire, anincrease of 1.7 points from the previous year (87.5%).Moreover, the percentage of facilities that carried outthe measurement at least once a month, as recom-mended in the JSDT standard (3), was 36.0%, anincrease of 2.9 points from 2008 (33.1%). However,these results are still unsatisfactory and the impor-tance of frequent measurement of endotoxin in dialy-sis fluid should be continuously educated.

Endotoxin concentration in dialysis fluid (Table 17)Table 17 shows a summary of endotoxin concentra-

tions in the dialysis fluid used in different medicalorganizations. The JSDT standard for endotoxin con-centration for standard dialysis fluid is less than0.05 EU/mL, and the percentage of facilities that sat-isfied this standard was 84.2% (vs. 89.1% in the 2006survey and 93.6% in the 2007 survey). Moreover, thepercentage of facilities that reported an endotoxinconcentration of 0.5 EU/mL or more was 3.2% (vs.1.0% in the 2006 survey and 0.4% in the 2007survey), suggesting that some facilities might haveused the wrong unit of measurement of endotoxinconcentration (3,5,6).

Frequency of measurement of bacterial count indialysis fluid (Table 18)

There were 3627 facilities that responded to ques-tions regarding the frequency of measurement of thebacterial count in the dialysis fluid. The number offacilities that measured bacterial count has beenincreasing since the start of the annual survey. A bac-terial count was measured at 60.7% of the 3627 facili-ties, 6.2 points increase from the end of 2008 (54.5%)(4). The percentage of facilities that measured bacte-rial count was only 37.1% at the end of 2006, anincrease of 23.6 points over the past 3 years (5).

The JSDT standard (3) recommends that the bac-terial count measurement should be monitored atleast once a month. The percentage of facilities thatsatisfied the standard was 25.8% in 2009, an increase

TAB

LE

13.

Ann

ual

chan

ges

inm

ajor

caus

esof

deat

h

Yea

r19

8319

8419

8519

8619

8719

8819

8919

9019

9119

9219

9319

9419

9519

96

Car

diac

failu

re30

.330

.531

.333

.232

.736

.533

.430

.430

.531

.129

.928

.225

.424

.1In

fect

ious

dise

ase

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

Mal

igna

nttu

mor

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

Cer

ebro

vasc

ular

dise

ase

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

Car

diac

infa

rcti

on5.

34.

85.

36.

16.

05.

45.

35.

85.

85.

85.

77.

17.

57.

4O

ther

s5.

14.

95.

74.

75.

24.

84.

44.

64.

44.

54.

14.

55.

86.

3U

nspe

cifie

d1.

92.

02.

82.

22.

41.

61.

92.

11.

82.

52.

62.

83.

22.

5

Yea

r19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

Car

diac

failu

re23

.924

.124

.323

.225

.525

.125

.025

.125

.824

.924

.023

.723

.6In

fect

ious

dise

ase

14.9

15.0

16.3

16.6

16.3

15.9

18.5

18.8

19.2

19.9

18.9

19.9

20.7

Mal

igna

nttu

mor

8.1

7.7

7.6

8.3

8.5

8.5

8.5

9.0

9.0

9.2

9.2

9.2

9.4

Cer

ebro

vasc

ular

dise

ase

12.6

12.1

11.3

11.3

11.6

11.2

10.7

10.6

9.8

9.4

8.9

8.6

8.4

Car

diac

infa

rcti

on8.

47.

97.

47.

07.

47.

46.

25.

45.

14.

44.

44.

14.

0O

ther

s6.

77.

07.

77.

99.

19.

09.

710

.39.

19.

59.

79.

710

.0U

nspe

cifie

d3.

53.

93.

68.

15.

76.

65.

66.

57.

38.

310

.310

.910

.6



of 5.0 points from 2008 (20.8%) (4). Thus, while themeasurement of the bacterial count in the dialysisfluid has become more common, the percentage offacilities that met the standard was still unsatisfac-tory, indicating that the importance of frequent mea-surement of bacterial count should be continuouslyeducated.

Bacterial count in dialysis fluid (Table 19)Bacterial counts in the dialysis fluid were reported

by 2062 facilities, 98.2% of which satisfied the JSDTstandard (3), that is, less than 100 cfu/mL. The per-centage of facilities that satisfied a bacterial count ofless than 0.1 cfu/mL, which ensures the entity ofultrapure dialysis fluid, was 54.5%.These percentageswere greater than those in 2008 (97.6% for less than100 cfu/mL and 50.7% for less than 0.1 cfu/mL) (4).

Cultivation media used for bacterial count in dialysisfluid (Table 19)

According to the JSDT standard, Reasoner’s no. 2agar (R2A) and tryptone glucose extract agar(TGEA) or equivalent media are recommended forthe cultivation of bacteria in the dialysis fluid (3).Thesurvey results showed that these media were used at78.4% of the facilities. The results of the 2007 surveyshowed that 73.4% of the facilities used R2A orTGEA, indicating that the percentage of facilitiesthat used a medium recommended in the standardincreased by 5.0 points over the past 2 years.

Sampling volume for measurement of bacterialcount in dialysis fluid (Table 20)

Generally, the sampling volume of dialysis fluid formeasuring bacterial count in plate media is less than1 mL. However, at least 10 mL of a dialysis fluidsample is required to measure a bacterial count ofless than 0.1 cfu/mL, which ensures the entity of

ultrapure dialysate fluid (3). The percentage thatsampled more than 10 mL for bacterial count was57.2% of the facilities that responded to the ques-tions regarding the volume of the sample. The per-centages of facilities that sampled at least 10 mL ofdialysis fluid were 46.5% in 2007 and 52.0% in 2008,increasing yearly (5,6).

Installation of ETRFs (Table 21)There were 4050 facilities that responded to the

questions regarding the installation of ETRFs.The percentage of facilities that installed ETRFwas 86.9%, an increase of 2.9 points from 2008(84.0%) (4).

Regarding the number of bedside consoles, 78 014bedside consoles (68.4%) were equipped with anETRF among 114 086 bedside consoles in the facili-ties that responded to the question about the numberof ETRFs installed.

Current status of PD therapyIn the 2009 survey, non-member facilities that

treated only PD patients were included in the surveyalthough they were not included in the previoussurveys. In this section, the tabulated results on thesurvey items related to PD are summarized.

Here, patients who underwent both PD and otherblood purification therapies using extracorporeal cir-culation such as HD and HDF are referred to as“PD + other therapy patients.” Patients who under-went only blood purification therapy using extracor-poreal circulation such as HD and HDF are referredto as “non-PD patients.” Patients who underwentblood purification therapy using extracorporeal cir-culation such as HD and HDF alone and have acatheter for PD inserted are referred to as “non-PD + catheter patients.”

TABLE 14. Change in annual crude death rate

Year Crude death rate (%) Year Crude death rate (%)

1983 9.0 1997 9.41984 8.9 1998 9.21985 9.1 1999 9.71986 9.0 2000 9.21987 8.5 2001 9.31988 9.2 2002 9.21989 7.9 2003 9.31990 9.6 2004 9.41991 8.9 2005 9.51992 9.7 2006 9.21993 9.4 2007 9.41994 9.5 2008 9.81995 9.7 2009 9.61996 9.4

S Nakai et al.24


TAB

LE

15.

Cum

ulat

ive

surv

ival

rate

sof

new

patie

nts

star

ted

ondi

alys

issi

nce

1983

Yearofintroduction

Numberofpatients

1-yearsurvivalrate

2-yearsurvivalrate

3-yearsurvivalrate

4-yearsurvivalrate

5-yearsurvivalrate

6-yearsurvivalrate

7-yearsurvivalrate

8-yearsurvivalrate

9-yearsurvivalrate

10-yearsurvivalrate

11-yearsurvivalrate

12-yearsurvivalrate

13-yearsurvivalrate

14-yearsurvivalrate

15-yearsurvivalrate

16-yearsurvivalrate

17-yearsurvivalrate

18-yearsurvivalrate

19-yearsurvivalrate

20-yearsurvivalrate

21-yearsurvivalrate

22-yearsurvivalrate

23-yearsurvivalrate

24-yearsurvivalrate

25-yearsurvivalrate

26-yearsurvivalrate

1983

988

90.

819

0.74

70.

682

0.63

30.

589

0.55

60.

523

0.48

50.

456

0.42

50.

396

0.37

20.

348

0.32

90.

307

0.28

80.

272

0.25

50.

241

0.22

60.

214

0.20

00.

189

0.17

90.

167

0.15

619

8410

713

0.81

70.

735

0.67

10.

620

0.57

70.

538

0.49

80.

465

0.43

50.

407

0.37

80.

353

0.32

90.

308

0.28

80.

271

0.25

30.

239

0.22

60.

212

0.19

80.

188

0.17

90.

167

0.15

819

8511

629

0.79

50.

720

0.66

00.

609

0.56

30.

520

0.48

50.

444

0.41

30.

385

0.36

10.

336

0.31

10.

289

0.27

10.

253

0.23

60.

221

0.20

80.

192

0.17

90.

168

0.15

60.

147

1986

1263

30.

799

0.72

50.

667

0.61

90.

566

0.52

10.

480

0.44

50.

408

0.37

90.

352

0.32

80.

305

0.28

40.

267

0.25

00.

234

0.22

10.

209

0.19

60.

183

0.17

30.

162

1987

1356

70.

815

0.73

80.

671

0.60

70.

556

0.50

70.

462

0.42

60.

393

0.36

40.

338

0.31

40.

293

0.27

10.

253

0.23

80.

220

0.20

30.

190

0.18

00.

170

0.15

919

8814

779

0.82

50.

741

0.66

70.

603

0.54

80.

499

0.45

60.

419

0.38

40.

353

0.32

60.

303

0.28

10.

260

0.24

20.

225

0.21

10.

196

0.18

60.

174

0.16

119

8914

572

0.84

90.

761

0.68

70.

618

0.56

10.

512

0.46

60.

427

0.39

20.

360

0.33

40.

309

0.28

70.

266

0.24

90.

232

0.21

70.

203

0.19

20.

179

1990

1652

20.

839

0.74

90.

674

0.61

00.

555

0.50

10.

459

0.41

90.

384

0.35

30.

325

0.30

00.

278

0.26

00.

243

0.22

70.

211

0.19

50.

182

1991

1822

70.

828

0.73

50.

662

0.59

80.

539

0.48

80.

445

0.40

70.

375

0.34

50.

318

0.29

30.

273

0.25

40.

237

0.22

10.

206

0.19

319

9219

918

0.82

20.

728

0.65

20.

589

0.53

20.

483

0.43

90.

401

0.36

80.

341

0.31

50.

291

0.27

10.

250

0.23

20.

216

0.20

119

9320

896

0.83

30.

743

0.66

70.

599

0.54

30.

491

0.44

70.

408

0.37

50.

345

0.31

80.

294

0.27

00.

252

0.23

50.

218

1994

2144

10.

830

0.74

40.

670

0.60

40.

545

0.49

30.

450

0.41

20.

376

0.34

50.

315

0.29

30.

271

0.25

00.

230

1995

2290

50.

841

0.75

40.

680

0.61

10.

554

0.50

50.

462

0.42

30.

387

0.35

50.

326

0.30

10.

277

0.25

419

9624

966

0.83

20.

750

0.67

40.

611

0.55

60.

509

0.45

80.

421

0.38

50.

353

0.32

40.

297

0.27

219

9725

575

0.83

80.

752

0.68

10.

620

0.56

30.

514

0.47

00.

427

0.39

10.

358

0.32

80.

300

1998

2687

60.

845

0.76

60.

698

0.63

70.

576

0.52

60.

477

0.43

50.

400

0.36

80.

337

1999

2784

10.

851

0.77

40.

706

0.64

10.

582

0.53

00.

484

0.44

30.

404

0.36

620

0029

330

0.85

60.

777

0.71

10.

649

0.59

10.

537

0.49

10.

446

0.40

720

0130

948

0.85

50.

775

0.70

70.

641

0.58

70.

535

0.48

70.

445

2002

3168

60.

859

0.78

10.

714

0.65

10.

591

0.53

70.

489

2003

3275

60.

860

0.78

30.

716

0.65

40.

596

0.54

220

0433

983

0.86

70.

791

0.72

40.

663

0.60

420

0535

072

0.86

30.

788

0.72

00.

658

2006

3632

50.

871

0.79

50.

728

2007

3715

70.

868

0.79

720

0837

922

0.86

8



Current status of combined use of PD and othertherapies in different medical organizations(Tables 22,23)

According to the facility survey, the number of PDpatients was 9858 at the end of 2009, an increase of558 patients from the 2008 survey (9300 patients).Moreover, the number of non-PD + catheter patientswas 437 and that of new patients who were started onPD in 2009 but introduced to other therapies in thesame year was 196.The total number of these patientswas 633. These 633 patients were not classified as PDpatients in the previous surveys.The sum of these 633patients and the abovementioned PD patients (i.e.the total number of PD-therapy-related patients) was10 491 (Table 22).

The details of the combined use of PD and othertherapies were investigated in the patient survey.According to the results, the number of PD + othertherapy patients was 1569 (Table 23). It was consid-ered that, in the abovementioned facility survey, mostof these PD + other therapy patients were counted asPD patients but some were probably counted aspatients who underwent HD or other therapies.According to the results of the patient survey at theend of 2009, the number of patients who respondedthat they underwent only PD (referred to as “PD-only patients”) was 6022. Therefore, the sum of thisand the number of PD + other therapy patients(1569) (i.e. the total number of patients who under-went PD alone or with other therapies) was 7591.Among these 7591 PD-treated patients, 1197 patients(15.8%) underwent HD or other therapies once aweek, 191 patients (2.5%) did so twice a week, and 53patients (0.7%) did so three times a week. The

'84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06 '08

Cum

ulat

ive

surv

ival

rat

e of

pat

ient

s st

arte

don

dia

lysi

s fo

r ea

ch y

ear

1-year survival rate



15-year survival rate20-year survival rate


1.0

0.8

0.6

0.4

0.2

0.0

FIG. 1. Changes in cumulative survival rate of patients startedon dialysis for each year.

TAB

LE

16.

Fre

quen

cies

ofm

easu

rem

ent

ofen

doto

xin

conc

entr

atio

nin

dial

ysis

fluid

indi

ffer

ent

med

ical

orga

niza

tions

(num

ber

ofbe

dsid

eco

nsol

es�

1)

Kin

dof

faci

lity

Non

eE

very

day

Eve

ryw

eek

Eve

ry2

wee

ksE

very

mon

thSe

vera

ltim

espe

rye

arO

nce

aye

arSu

btot

alU

nspe

cifie

dN

oin

form

atio

nav

aila

ble

Tota

l

Nat

iona

lpub

licun

iver

sity

hosp

ital

31

01

2319

350

20

52(%

)(6

.0)

(2.0

)(0

.0)

(2.0

)(4

6.0)

(38.

0)(6

.0)

(100

.0)

Pri

vate

univ

ersi

tyho

spit

al3

02

823

223

611

062

(%)

(4.9

)(0

.0)

(3.3

)(1

3.1)

(37.

7)(3

6.1)

(4.9

)(1

00.0

)N

atio

nalh

ospi

tal

100

10

914

236

30

39(%

)(2

7.8)

(0.0

)(2

.8)

(0.0

)(2

5.0)

(38.

9)(5

.6)

(100

.0)

Pre

fect

ural

Mun

icip

alV

illag

eho

spit

al42

13

1297

180

6339

821

842

7(%

)(1

0.6)

(0.3

)(0

.8)

(3.0

)(2

4.4)

(45.

2)(1

5.8)

(100

.0)

Soci

alin

sura

nce

hosp

ital

60

02

1732

663

00

63(%

)(9

.5)

(0.0

)(0

.0)

(3.2

)(2

7.0)

(50.

8)(9

.5)

(100

.0)

“Kou

seir

en”

hosp

ital

80

15

4338

1711

27

112

0(%

)(7

.1)

(0.0

)(0

.9)

(4.5

)(3

8.4)

(33.

9)(1

5.2)

(100

.0)

Oth

erpu

blic

hosp

ital

161

63

6168

1817

36

118

0(%

)(9

.2)

(0.6

)(3

.5)

(1.7

)(3

5.3)

(39.

3)(1

0.4)

(100

.0)

Pri

vate

gene

ralh

ospi

tal

131

27

2940

1210

45

111

0(%

)(1

2.5)

(1.0

)(1

.9)

(6.7

)(2

7.9)

(38.

5)(1

1.5)

(100

.0)

Pri

vate

hosp

ital

128

618

5328

939

016

210

4661

711

14(%

)(1

2.2)

(0.6

)(1

.7)

(5.1

)(2

7.6)

(37.

3)(1

5.5)

(100

.0)

Pri

vate

clin

ic18

111

5113

844

866

627

117

6687

3018

83(%

)(1

0.2)

(0.6

)(2

.9)

(7.8

)(2

5.4)

(37.

7)(1

5.3)

(100

.0)

Tota

l41

021

8422

910

3914

6955

738

0919

348

4050

(%)

(10.

8)(0

.6)

(2.2

)(6

.0)

(27.

3)(3

8.6)

(14.

6)(1

00.0

)

Kou

seir

en:a

nas

soci

atio

nfo

rw

elfa

rebe

long

ing

toag

ricu

ltur

alco

oper

ativ

eas

soci

atio

ns.

S Nakai et al.26


TAB

LE

17.

End

otox

inco

ncen

trat

ion

indi

alys

isflu

id(E

U/m

L)

indi

ffer

ent

med

ical

orga

niza

tions

(num

ber

ofbe

dsid

eco

nsol

es�

1)

Kin

dof

faci

lity

End

otox

inco

ncen

trat

ion

(EU

/mL

)in

dial

ysis

fluid

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Les

sth

an0.

001

0.00

1~0.

01~

0.05

~0.

1~0.

25~

0.5~

Nat

iona

lPub

licun

iver

sity

hosp

ital

2410

63

20

146

24

52(%

)(5

2.2)

(21.

7)(1

3.0)

(6.5

)(4

.3)

(0.0

)(2

.2)

(100

.0)

Pri

vate

univ

ersi

tyho

spit

al33

115

42

11

572

362

(%)

(57.

9)(1

9.3)

(8.8

)(7

.0)

(3.5

)(1

.8)

(1.8

)(1

00.0

)N

atio

nalh

ospi

tal

146

30

21

127

210

39(%

)(5

1.9)

(22.

2)(1

1.1)

(0.0

)(7

.4)

(3.7

)(3

.7)

(100

.0)

Pre

fect

ural

Mun

icip

alV

illag

eho

spit

al21

856

2918

1210

634

926

5242

7(%

)(6

2.5)

(16.

0)(8

.3)

(5.2

)(3

.4)

(2.9

)(1

.7)

(100

.0)

Soci

alin

sura

nce

hosp

ital

3112

52

31

256

07

63(%

)(5

5.4)

(21.

4)(8

.9)

(3.6

)(5

.4)

(1.8

)(3

.6)

(100

.0)

“Kou

seir

en”

hosp

ital

5620

77

23

499

1110

120

(%)

(56.

6)(2

0.2)

(7.1

)(7

.1)

(2.0

)(3

.0)

(4.0

)(1

00.0

)O

ther

publ

icho

spit

al90

2312

109

33

150

1218

180

(%)

(60.

0)(1

5.3)

(8.0

)(6

.7)

(6.0

)(2

.0)

(2.0

)(1

00.0

)P

riva

tege

nera

lhos

pita

l43

1410

76

64

905

1511

0(%

)(4

7.8)

(15.

6)(1

1.1)

(7.8

)(6

.7)

(6.7

)(4

.4)

(100

.0)

Pri

vate

hosp

ital

473

179

8661

4224

3389

878

138

1114

(%)

(52.

7)(1

9.9)

(9.6

)(6

.8)

(4.7

)(2

.7)

(3.7

)(1

00.0

)P

riva

tecl

inic

883

276

163

8268

3150

1553

115

215

1883

(%)

(56.

9)(1

7.8)

(10.

5)(5

.3)

(4.4

)(2

.0)

(3.2

)(1

00.0

)To

tal

1865

607

326

194

148

8010

533

2525

347

240

50(%

)(5

6.1)

(18.

3)(9

.8)

(5.8

)(4

.5)

(2.4

)(3

.2)

(100

.0)

Kou

seir

en:a

nas

soci

atio

nfo

rw

elfa

rebe

long

ing

toag

ricu

ltur

alco

oper

ativ

eas

soci

atio

ns.

TAB

LE

18.

Fre

quen

cies

ofm

easu

rem

ent

ofba

cter

ial

coun

tin

dial

ysis

fluid

indi

ffer

ent

med

ical

orga

niza

tions

(num

ber

ofbe

dsid

eco

nsol

es�

1)

Kin

dof

faci

lity

Mea

sure

men

tfr

eque

ncy

ofba

cter

ialc

ount

inth

edi

alys

isflu

id

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Non

eE

very

day

Eve

ryw

eek

Eve

rytw

ow

eeks

Eve

rym

onth

Seve

ralt

imes

per

year

Onc

ea

year

Nat

iona

lpub

licun

iver

sity

hosp

ital

120

00

1616

246

60

52(%

)(2

6.1)

(0.0

)(0

.0)

(0.0

)(3

4.8)

(34.

8)(4

.3)

(100

.0)

Pri

vate

univ

ersi

tyho

spit

al13

01

416

206

602

062

(%)

(21.

7)(0

.0)

(1.7

)(6

.7)

(26.

7)(3

3.3)

(10.

0)(1

00.0

)N

atio

nalh

ospi

tal

220

21

27

236

30

39(%

)(6

1.1)

(0.0

)(5

.6)

(2.8

)(5

.6)

(19.

4)(5

.6)

(100

.0)

Pre

fect

ural

Mun

icip

alV

illag

eho

spit

al16

40

18

6296

4637

742

842

7(%

)(4

3.5)

(0.0

)(0

.3)

(2.1

)(1

6.4)

(25.

5)(1

2.2)

(100

.0)

Soci

alin

sura

nce

hosp

ital

140

10

1219

854

90

63(%

)(2

5.9)

(0.0

)(1

.9)

(0.0

)(2

2.2)

(35.

2)(1

4.8)

(100

.0)

“Kou

seir

en”

hosp

ital

370

03

3721

1110

910

112

0(%

)(3

3.9)

(0.0

)(0

.0)

(2.8

)(3

3.9)

(19.

3)(1

0.1)

(100

.0)

Oth

erpu

blic

hosp

ital

610

27

4241

1316

613

118

0(%

)(3

6.7)

(0.0

)(1

.2)

(4.2

)(2

5.3)

(24.

7)(7

.8)

(100

.0)

Pri

vate

gene

ralh

ospi

tal

460

26

1816

1210

08

211

0(%

)(4

6.0)

(0.0

)(2

.0)

(6.0

)(1

8.0)

(16.

0)(1

2.0)

(100

.0)

Pri

vate

hosp

ital

381

110

3821

623

611

799

910

411

1114

(%)

(38.

1)(0

.1)

(1.0

)(3

.8)

(21.

6)(2

3.6)

(11.

7)(1

00.0

)P

riva

tecl

inic

675

721

108

290

389

190

1680

170

3318

83(%

)(4

0.2)

(0.4

)(1

.3)

(6.4

)(1

7.3)

(23.

2)(1

1.3)

(100

.0)

Tota

l14

258

4017

571

186

140

736

2736

756

4050

(%)

(39.

3)(0

.2)

(1.1

)(4

.8)

(19.

6)(2

3.7)

(11.

2)(1

00.0

)

Kou

seir

en:a

nas

soci

atio

nfo

rw

elfa

rebe

long

ing

toag

ricu

ltur

alco

oper

ativ

eas

soci

atio

ns.



PD + other therapy patients (1569) accounted for20.7% of the PD-treated patients (7591).

Table 23 shows the current status of the combineduse of PD and other therapies in different medical

organizations. To easily understand the differences inthe distribution of patients who underwent differenttherapies among medical organizations, national,public, and private universities were classified as uni-

TABLE 19. Number of facilities for different bacterial counts in dialysis fluid (cfu/mL) and cultivation media (number ofbedside consoles �1) dialysis fluid

Media used for bacterialcultivation of dialysis fluid

Bacterial count in dialysis fluid (cfu/mL)

Subtotal UnspecifiedNo information

available TotalLess than 0.1 0.1~ 1~ 10~ 100~

General agar medium 149 35 31 14 2 231 15 0 246(%) (64.5) (15.2) (13.4) (6.1) (0.9) (100.0)R2A medium 625 258 239 123 25 1270 51 3 1324(%) (49.2) (20.3) (18.8) (9.7) (2.0) (100.0)TGEA medium 184 57 33 8 3 285 6 1 292(%) (64.6) (20.0) (11.6) (2.8) (1.1) (100.0)Blood agar medium 26 4 1 2 0 33 4 0 37(%) (78.8) (12.1) (3.0) (6.1) (0.0) (100.0)TSA medium 7 2 1 0 0 10 2 0 12(%) (70.0) (20.0) (10.0) (0.0) (0.0) (100.0)Other media 77 19 23 9 2 130 18 2 150(%) (59.2) (14.6) (17.7) (6.9) (1.5) (100.0)Subtotal 1068 375 328 156 32 1959 96 6 2061(%) (54.5) (19.1) (16.7) (8.0) (1.6) (100.0)Unspecified 54 16 17 9 6 102 397 949 1448(%) (52.9) (15.7) (16.7) (8.8) (5.9) (100.0)No information available 1 0 0 0 0 1 1 539 541(%) (100.0) (0.0) (0.0) (0.0) (0.0) (100.0)Total 1123 391 345 165 38 2062 494 1494 4050(%) (54.5) (19.0) (16.7) (8.0) (1.8) (100.0)

The values in parentheses under each figure represent the percentage relative to the total in each row. R2A, reasoner’s No. 2 agar;TGEA,tryptone glucose extract agar; TSA, tryptic soy agar.

TABLE 20. Number of facilities for different bacterial counts in dialysis fluid (cfu/mL) and volumes of samples formeasurement of bacterial count (number of bedside consoles �1)

Amount of sample

Bacterial count in dialysis fluid (cfu/mL)


available TotalLess than 0.1 0.1~ 1~ 10~ 100~

less than 1 mL 147 26 23 7 0 203 22 0 225(%) (72.4) (12.8) (11.3) (3.4) (0.0) (100.0)1 mL~ 326 125 125 57 11 644 51 1 696(%) (50.6) (19.4) (19.4) (8.9) (1.7) (100.0)10 mL~ 257 121 103 51 12 544 23 5 572(%) (47.2) (22.2) (18.9) (9.4) (2.2) (100.0)50 mL~ 247 88 59 30 11 435 12 1 448(%) (56.8) (20.2) (13.6) (6.9) (2.5) (100.0)100 mL~ 93 24 23 8 2 150 3 0 153(%) (62.0) (16.0) (15.3) (5.3) (1.3) (100.0)500 mL~ 13 3 4 7 0 27 2 0 29(%) (48.1) (11.1) (14.8) (25.9) (0.0) (100.0)1 L~ 14 1 1 1 0 17 3 0 20(%) (82.4) (5.9) (5.9) (5.9) (0.0) (100.0)10 L~ 5 0 0 0 1 6 1 0 7(%) (83.3) (0.0) (0.0) (0.0) (16.7) (100.0)Subtotal 1102 388 338 161 37 2026 117 7 2150(%) (54.4) (19.2) (16.7) (7.9) (1.8) (100.0)Unspecified 21 3 7 4 1 36 377 949 1362(%) (58.3) (8.3) (19.4) (11.1) (2.8) (100.0)No information available 0 0 0 0 0 0 0 538 538(%) (0.0) (0.0) 0.0) (0.0) (0.0) (0.0)Total 1123 391 345 165 38 2062 494 1494 4050(%) (54.5) (19.0) (16.7) (8.0) (1.8) (100.0)

The values in parentheses under each figure represent the percentage relative to the total in each row.

S Nakai et al.28


TAB

LE

21.

Per

cent

ages

offa

cilit

ies

that

have

beds

ide

cons

oles

with

endo

toxi

nre

tent

ive

filte

r(E

TR

F)

indi

ffer

ent

med

ical

orga

niza

tions

(num

ber

ofbe

dsid

eco

nsol

es�

1)

Per

cent

ages

offa

cilit

ies

that

have

beds

ide

cons

oles

wit

hE

TR

F(%

)

Subt

otal

Mea

nSD

Kin

dof

faci

lity

0%(N

oE

TR

F)

<10%

10~

20~

30~

40~

50~

60~

70~

80~

90~

100%

(All

cons

oles

equi

pped

wit

hE

TR

F)

Nat

iona

lpub

licun

iver

sity

hosp

ital

30

01

00

00

10

344

5291

.77

25.5

3

(%)

(5.8

)(0

.0)

(0.0

)(1

.9)

(0.0

)(0

.0)

(0.0

)(0

.0)

(1.9

)(0

.0)

(5.8

)(8

4.6)

(100

.0)

Pri

vate

univ

ersi

tyho

spit

al3

11

02

22

20

13

4562

85.2

630

.01

(%)

(4.8

)(1

.6)

(1.6

)(0

.0)

(3.2

)(3

.2)

(3.2

)(3

.2)

(0.0

)(1

.6)

(4.8

)(7

2.6)

(100

.0)

Nat

iona

lhos

pita

l1

00

00

01

21

21

3139

92.5

419

.20

(%)

(2.6

)(0

.0)

(0.0

)(0

.0)

(0.0

)(0

.0)

(2.6

)(5

.1)

(2.6

)(5

.1)

(2.6

)(7

9.5)

(100

.0)

Pre

fect

ural

Mun

icip

alV

illag

eho

spit

al36

2113

98

610

88

1126

271

427

77.6

436

.84

(%)

(8.4

)(4

.9)

(3.0

)(2

.1)

(1.9

)(1

.4)

(2.3

)(1

.9)

(1.9

)(2

.6)

(6.1

)(6

3.5)

(100

.0)

Soci

alin

sura

nce

hosp

ital

52

22

41

21

15

632

6374

.55

36.3

8(%

)(7

.9)

(3.2

)(3

.2)

(3.2

)(6

.3)

(1.6

)(3

.2)

(1.6

)(1

.6)

(7.9

)(9

.5)

(50.

8)(1

00.0

)“K

ouse

iren

”ho

spit

al4

54

59

23

14

17

7512

078

.42

34.1

8(%

)(3

.3)

(4.2

)(3

.3)

(4.2

)(7

.5)

(1.7

)(2

.5)

(0.8

)(3

.3)

(0.8

)(5

.8)

(62.

5)(1

00.0

)O

ther

publ

icho

spit

al13

58

42

27

57

85

114

180

78.7

734

.71

(%)

(7.2

)(2

.8)

(4.4

)(2

.2)

(1.1

)(1

.1)

(3.9

)(2

.8)

(3.9

)(4

.4)

(2.8

)(6

3.3)

(100

.0)

Pri

vate

gene

ralh

ospi

tal

136

62

13

10

21

768

110

73.5

240

.49

(%)

(11.

8)(5

.5)

(5.5

)(1

.8)

(0.9

)(2

.7)

(0.9

)(0

.0)

(1.8

)(0

.9)

(6.4

)(6

1.8)

(100

.0)

Pri

vate

hosp

ital

136

5250

3535

2829

2019

3164

615

1114

70.6

240

.06

(%)

(12.

2)(4

.7)

(4.5

)(3

.1)

(3.1

)(2

.5)

(2.6

)(1

.8)

(1.7

)(2

.8)

(5.7

)(5

5.2)

(100

.0)

Pri

vate

clin

ic31

512

293

6552

5140

4732

4976

941

1883

64.0

942

.67

(%)

(16.

7)(6

.5)

(4.9

)(3

.5)

(2.8

)(2

.7)

(2.1

)(2

.5)

(1.7

)(2

.6)

(4.0

)(5

0.0)

(100

.0)

Tota

l52

921

417

712

311

395

9586

7510

919

822

3640

5069

.76

40.6

3(%

)(1

3.1)

(5.3

)(4

.4)

(3.0

)(2

.8)

(2.3

)(2

.3)

(2.1

)(1

.9)

(2.7

)(4

.9)

(55.

2)(1

00.0

)

Kou

seir

en:a

nas

soci

atio

nfo

rw

elfa

rebe

long

ing

toag

ricu

ltur

alco

oper

ativ

eas

soci

atio

ns.



versity hospitals. National organizations, prefecturaland municipal organizations, social insurance organi-zations, welfare federation of agricultural coopera-tives, and other public organizations were classifiedas public hospitals. Private general hospitals andprivate hospitals were classified as private hospitals.Private clinics were simply classified as private clinics.The data shown in Table 23 are analyzed followingthe new classification as follows. According to theanalytical results, most of the non-PD patients weretreated in private hospitals and clinics and few weretreated in university and public hospitals (universityhospitals, 0.9%; public hospitals, 13.9%; private hos-pitals, 33.1%; private clinics, 52.1%). In contrast,many of the PD-only patients were treated in univer-sity and public hospitals and few were treated inprivate clinics (university hospitals, 19.1%; publichospitals, 43.8%; private hospitals, 26.9%; privateclinics, 10.2%). The number of PD + other therapypatients showed an intermediate distribution of theabove two groups of patients (university hospitals,10.8%; public hospitals, 37.2%; private hospitals,26.7%; private clinics, 25.3%). The distribution of thenumber of non-PD + catheter patients was closer tothe number of non-PD patients than the number ofPD + other therapy patients.

The above findings indicate a tendency that, inJapan, PD patients are mainly treated in universityand public hospitals, whereas non-PD patients aremainly treated in private medical organizations.

Combined use of PD and other therapies for variousage groups (Table 24)

The relationship of the current status of combineduse of PD and other therapies with age was analyzed(Table 24). The percentage of PD-treated patients(consisting of PD-only patients and PD + othertherapy patients) among all dialysis patients was90.0% for patients younger than 15 years. The per-centage decreased with increasing age (15–29 yearsold, 10.7%; 30–44 years old, 5.9%; 45–59 years old,4.9%; 60–74 years old, 3.0%; 75–89 years old, 2.0%;

90 years or older, 2.0%). The mean age of non-PDpatients was 65.9 years, whereas that of PD-onlypatients was younger at 61.2 years.

Combined use of PD and other therapies fordifferent dialysis periods (Table 25)

The relationship between the current status ofcombined use of PD with other therapies and dialysisperiod was analyzed (Table 25). The percentage ofPD-treated patients, consisting of PD-only patientsand PD + other therapy patients, was 5.7% forpatients on dialysis for less than 2 years anddecreased with increasing dialysis period (2–4 years,4.5%; 5–9 years, 2.7%; 10–14 years, 1.3%; 15–19 years, 0.7%; 20–24 years, 0.5%; 25 years or more,0.5%). Patients who underwent both PD and othertherapies were observed even among patients ondialysis for less than 2 years.

The percentage of PD + other therapy patientsamong PD-treated patients (consisting of PD-onlypatients and PD + other therapy patients) was as highas 40–50% for patients on dialysis for 5 years or more(less than 2 years, 7.4%; 2–4 years, 19.9%; 5–9 years,36.1%; 10–14 years, 51.4%; 15–19 years, 52.8%;20–24 years, 46.2%; 25 years or more, 40.9%).

Combined use of PD and other therapies fordifferent PD periods (Table 26)

Peritoneal dialysis period was calculated forpatients who underwent PD at the time of the survey,and its relationship with the current status of com-bined use of PD and other therapies was analyzed(Table 26). The mean PD period of PD-only patientswas 2.6 years, whereas that of PD + other therapypatients was nearly twofold higher at 4.6–5.9 years.

Combined use of PD and other therapies fordifferent primary diseases (Table 27)

The relationship between the current status ofcombined use of PD and other therapies and primarydiseases was analyzed (Table 27). The percentages ofpatients with diabetic nephropathy as the primary

TABLE 22. Number of patients who underwent peritoneal dialysis (PD) and other therapies determined by results offacility survey

Patients who responded in facility survey that they underwentdaytime dialysis, nighttime dialysis, or home HD

Methodof therapy

PD (according to results of facilitysurvey)

Non-PD + catheter patients Patients who were started on PD in 2009but introduced to other therapies inthe same year

Total

Numberof patients

9858 437 196 10 491Among the above, 1720 patients

underwent both PD and others.

S Nakai et al.30


TAB

LE

23.

Cur

rent

stat

usof

com

bine

dus

eof

peri

tone

aldi

alys

is(P

D)

and

othe

rth

erap

ies

indi

ffer

ent

med

ical

orga

niza

tions

(for

all

dial

ysis

patie

nts)

Kin

dof

faci

lity

Cur

rent

stat

usof

com

bine

dus

eof

PD

and

othe

rth

erap

ies

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Non

-PD

PD

only

Non

-PD

+ca

thet

er

PD

+ot

her

ther

apie

s(o

nce

aw

eek)

PD

+ot

her

ther

apie

s(t

wic

ea

wee

k)

PD

+ot

her

ther

apie

s(t

hree

tim

esa

wee

k)

PD

+ot

her

ther

apie

s(o

ther

freq

uenc

y)

Nat

iona

lPub

licun

iver

sity

hosp

ital

345

357

134

61

074

40

230

974

(%)

(46.

4)(4

8.0)

(0.1

)(4

.6)

(0.8

)(0

.1)

(0.0

)(1

00.0

)P

riva

teun

iver

sity

hosp

ital

155

179

58

116

71

42

482

046

62

948

(%)

(62.

5)(3

2.0)

(0.3

)(4

.7)

(0.3

)(0

.0)

(0.2

)(1

00.0

)N

atio

nalh

ospi

tal

320

850

131

00

419

023

565

4(%

)(7

6.4)

(20.

3)(0

.0)

(3.1

)(0

.2)

(0.0

)(0

.0)

(100

.0)

Pre

fect

ural

Mun

icip

alV

illag

eho

spit

al13

706

1110

3317

231

525

1508

20

413

119

213

(%)

(90.

9)(7

.4)

(0.2

)(1

.1)

(0.2

)(0

.0)

(0.2

)(1

00.0

)So

cial

insu

ranc

eho

spit

al2

536

209

749

31

02

805

061

33

418

(%)

(90.

4)(7

.5)

(0.2

)(1

.7)

(0.1

)(0

.0)

(0.0

)(1

00.0

)“K

ouse

iren

”ho

spit

al6

076

418

790

93

46

607

12

343

895

1(%

)(9

2.0)

(6.3

)(0

.1)

(1.4

)(0

.1)

(0.0

)(0

.1)

(100

.0)

Oth

erpu

blic

hosp

ital

750

781

723

138

139

188

525

01

764

1028

9(%

)(8

8.1)

(9.6

)(0

.3)

(1.6

)(0

.2)

(0.1

)(0

.2)

(100

.0)

Pri

vate

gene

ralh

ospi

tal

526

630

66

5834

81

567

90

146

97

148

(%)

(92.

7)(5

.4)

(0.1

)(1

.0)

(0.6

)(0

.1)

(0.0

)(1

00.0

)P

riva

teho

spit

al66

435

1311

4823

926

1043

6811

22

1421

282

326

(%)

(97.

5)(1

.9)

(0.1

)(0

.4)

(0.0

)(0

.0)

(0.1

)(1

00.0

)P

riva

tecl

inic

113

043

614

7728

861

1533

114

131

031

944

146

075

(%)

(99.

0)(0

.5)

(0.1

)(0

.3)

(0.1

)(0

.0)

(0.0

)(1

00.0

)To

tal

216

785

6022

210

1197

191

5312

822

458

63

5740

728

199

6(%

)(9

6.5)

(2.7

)(0

.1)

(0.5

)(0

.1)

(0.0

)(0

.1)

(100

.0)

Kou

seir

en:a

nas

soci

atio

nfo

rw

elfa

rebe

long

ing

toag

ricu

ltur

alco

oper

ativ

eas

soci

atio

ns.



TAB

LE

24.

Cur

rent

stat

usof

com

bine

dus

eof

peri

tone

aldi

alys

is(P

D)

and

othe

rth

erap

ies

for

diff

eren

tag

egr

oups

(for

all

dial

ysis

patie

nts)

Age

(yea

rs)

Cur

rent

stat

usof

com

bine

dus

eof

PD

and

othe

rth

erap

ies

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Non

-PD

PD

only

Non

-PD

+ca

thet

er

PD

+ot

her

ther

apie

s(o

nce

aw

eek)

PD

+ot

her

ther

apie

s(t

wic

ea

wee

k)

PD

+ot

her

ther

apie

s(t

hree

tim

esa

wee

k)

PD

+ot

her

ther

apie

s(o

ther

freq

uenc

y)

<15

654

00

00

060

048

108

(%)

(10.

0)(9

0.0)

(0.0

)(0

.0)

(0.0

)(0

.0)

(0.0

)(1

00.0

)15

–29

102

696

421

50

11

153

030

01

453

(%)

(89.

0)(8

.3)

(0.3

)(1

.8)

(0.4

)(0

.0)

(0.1

)(1

00.0

)30

–44

1204

454

028

173

247

1512

831

03

331

1616

2(%

)(9

3.9)

(4.2

)(0

.2)

(1.3

)(0

.2)

(0.1

)(0

.1)

(100

.0)

45–5

947

126

1789

5048

567

1557

4958

91

1249

962

089

(%)

(95.

0)(3

.6)

(0.1

)(1

.0)

(0.1

)(0

.0)

(0.1

)(1

00.0

)60

–74

9903

525

1798

430

8220

3910

222

11

2586

512

808

7(%

)(9

6.9)

(2.5

)(0

.1)

(0.4

)(0

.1)

(0.0

)(0

.0)

(100

.0)

75–8

954

970

978

2985

1310

1656

101

114

677

7077

9(%

)(9

8.0)

(1.7

)(0

.1)

(0.2

)(0

.0)

(0.0

)(0

.0)

(100

.0)

90–

257

648

13

01

02

629

067

23

301

(%)

(98.

0)(1

.8)

(0.0

)(0

.1)

(0.0

)(0

.0)

(0.0

)(1

00.0

)To

tal

216

783

6022

210

1197

191

5312

822

458

43

5739

228

197

9(%

)(9

6.5)

(2.7

)(0

.1)

(0.5

)(0

.1)

(0.0

)(0

.1)

(100

.0)

No

info

rmat

ion

avai

labl

e2

00

00

00

20

1517

(%)

(100

.0)

(0.0

)(0

.0)

(0.0

)(0

.0)

(0.0

)(0

.0)

(100

.0)

Tota

l21

678

560

2221

011

9719

153

128

224

586

357

407

281

996

(%)

(96.

5)(2

.7)

(0.1

)(0

.5)

(0.1

)(0

.0)

(0.1

)(1

00.0

)M

ean

65.9

461

.22

60.5

556

.86

57.4

162

.66

58.0

365

.75

67.6

765

.82

65.7

6SD

12.5

014

.35

13.7

012

.31

12.7

013

.22

11.9

612

.60

12.5

012

.76

12.6

3

S Nakai et al.32


disease were 35.4% for non-PD patients, 28.5% forPD-only patients, and 25.0% for PD + other therapypatients.

Items associated with CKD-MBDIn this section, the tabulated results on the survey

items related to CKD-MBD are summarized.

Blood test items associated with CKD-MBD(Tables 28–34)

According to the CKD-MBD Guidelines (1)issued in 2008, it is recommended that the predialysiscorrected serum calcium level be maintained withinthe range of 8.4–10.0 mg/dL. The percentage ofpatients with a predialysis corrected serum calciumlevel within this range was 75.4% (Table 28).

Similarly, it is also recommended in the aboveGuidelines (1) that the predialysis serum phosphoruslevel be maintained within the range of 3.5–6.0 mg/dL. The percentage of patients with a predialysisserum phosphorus level within this range was 65.8%(Table 29).

In the 2009 survey, the predialysis serum magne-sium level was first investigated. Predialysis serummagnesium levels were 1.8–3.4 mg/dL in 94.6% of allthe dialysis patients (Table 30).

Table 31 shows the results of tests for serum PTHlevel. Among all the dialysis patients, 89.3% usedintact PTH, whereas 9.9% used whole PTH. The per-centage of patients who used high-sensitivity (HS)-PTH was only 0.4%.

The mean serum intact- and whole-PTH levels inall the target patients were 164 (�166) and 106(�116) pg/mL, respectively (Tables 32,33). The per-centage of patients who satisfied the serumintact-PTH level recommended in the CKD-MBDGuidelines (1) (i.e. within the range of 61–180 pg/mL) was 44.7%, which is less than one-half the entiretarget patients.

Table 34 shows the predialysis serum ALP levels.Among all the dialysis patients, 82.8% had a predi-alysis serum ALP level within the range of 111–360 IU/L, the normal range determined by the JapanSociety of Clinical Chemistry (JSCC) standardizationmethod

Administration or non-administration of phosphatebinders (Tables 35,36)

Table 35 shows the results of the administration ornon-administration of phosphate binders for differ-ent dialysis methods. In this table, only the patientswho provided answers other than “unspecified” to allthe questions regarding calcium carbonate, seve-lamer HCl, and lanthanum carbonate were targeted.

TAB

LE

25.

Cur

rent

stat

usof

com

bine

dus

eof

PD

and

othe

rth

erap

ies

for

diff

eren

tdi

alys

ispe

riod

s(f

oral

lta

rget

patie

nts)

Dia

lysi

spe

riod

(yea

rs)

Cur

rent

stat

usof

com

bine

dus

eof

PD

and

othe

rth

erap

ies

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Non

-PD

PD

only

Non

-PD

+ca

thet

er

PD

+ot

her

ther

apie

s(o

nce

aw

eek)

PD

+ot

her

ther

apie

s(t

wic

ea

wee

k)

PD

+ot

her

ther

apie

s(t

hree

tim

esa

wee

k)

PD

+ot

her

ther

apie

s(o

ther

freq

uenc

y)

<247

711

2681

4715

524

926

5065

30

1380

864

461

(%)

(94.

2)(5

.3)

(0.1

)(0

.3)

(0.0

)(0

.0)

(0.1

)(1

00.0

)2–

455

151

2076

3941

065

1426

5778

12

1469

072

473

(%)

(95.

4)(3

.6)

(0.1

)(0

.7)

(0.1

)(0

.0)

(0.0

)(1

00.0

)5–

955

431

990

5644

860

1933

5703

71

1421

371

251

(%)

(97.

2)(1

.7)

(0.1

)(0

.8)

(0.1

)(0

.0)

(0.1

)(1

00.0

)10

–14

2771

017

742

124

345

2428

116

06

958

3507

4(%

)(9

8.6)

(0.6

)(0

.1)

(0.4

)(0

.1)

(0.0

)(0

.1)

(100

.0)

15–1

914

327

5122

405

48

1445

70

365

418

111

(%)

(99.

1)(0

.4)

(0.2

)(0

.3)

(0.0

)(0

.0)

(0.1

)(1

00.0

)20

–24

783

821

112

02

47

878

01

998

987

6(%

)(9

9.5)

(0.3

)(0

.0)

(0.2

)(0

.0)

(0.0

)(0

.1)

(100

.0)

25–

861

726

38

30

78

664

02

086

1075

0(%

)(9

9.5)

(0.3

)(0

.0)

(0.1

)(0

.0)

(0.0

)(0

.1)

(100

.0)

Tota

l21

678

560

2221

011

9719

153

128

224

586

357

407

281

996

(%)

(96.

5)(2

.7)

(0.1

)(0

.5)

(0.1

)(0

.0)

(0.1

)(1

00.0

)M

ean

7.12

2.87

6.89

5.75

5.91

6.49

7.94

7.00

3.33

6.82

6.97

SD7.

213.

676.

014.

644.

975.

777.

437.

151.

537.

097.

14



TAB

LE

26.

Cur

rent

stat

usof

com

bine

dus

eof

peri

tone

aldi

alys

is(P

D)

and

othe

rth

erap

ies

for

diff

eren

tP

Dpe

riod

s(f

orP

D-t

reat

edpa

tient

s)

PD

peri

od(y

ears

)

Cur

rent

stat

usof

com

bine

dus

eof

PD

and

othe

rth

erap

ies

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Non

-PD

PD

only

Non

-PD

+ca

thet

er

PD

+ot

her

ther

apie

s(o

nce

aw

eek)

PD

+ot

her

ther

apie

s(t

wic

ea

wee

k)

PD

+ot

her

ther

apie

s(t

hree

tim

esa

wee

k)

PD

+ot

her

ther

apie

s(o

ther

freq

uenc

y)

<10

1093

058

94

611

700

011

70(%

)(0

.0)

(93.

4)(0

.0)

(5.0

)(0

.8)

(0.3

)(0

.5)

(100

.0)

1–2

015

510

195

288

1918

010

018

01(%

)(0

.0)

(86.

1)(0

.0)

(10.

8)(1

.6)

(0.4

)(1

.1)

(100

.0)

3–4

086

40

216

376

811

310

011

31(%

)(0

.0)

(76.

4)(0

.0)

(19.

1)(3

.3)

(0.5

)(0

.7)

(100

.0)

5–6

042

90

176

305

1165

10

065

1(%

)(0

.0)

(65.

9)(0

.0)

(27.

0)(4

.6)

(0.8

)(1

.7)

(100

.0)

7–9

024

80

161

195

844

10

044

1(%

)(0

.0)

(56.

2)(0

.0)

(36.

5)(4

.3)

(1.1

)(1

.8)

(100

.0)

10–1

40

101

081

242

2022

80

022

8(%

)(0

.0)

(44.

3)(0

.0)

(35.

5)(1

0.5)

(0.9

)(8

.8)

(100

.0)

15–

036

028

51

171

00

71(%

)(0

.0)

(50.

7)(0

.0)

(39.

4)(7

.0)

(1.4

)(1

.4)

(100

.0)

Tota

l0

4322

091

515

231

7354

930

054

93(%

)(0

.0)

(78.

7)(0

.0)

(16.

7)(2

.8)

(0.6

)(1

.3)

(100

.0)

No

info

rmat

ion

avai

labl

e0

1700

028

239

2255

2098

00

2098

(%)

(0.0

)(8

1.0)

(0.0

)(1

3.4)

(1.9

)(1

.0)

(2.6

)(1

00.0

)

Tota

l0

6022

011

9719

153

128

7591

00

7591

(%)

(0.0

)(7

9.3)

(0.0

)(1

5.8)

(2.5

)(0

.7)

(1.7

)(1

00.0

)M

ean

2.60

5.17

5.61

4.61

5.88

3.17

3.17

SD2.

943.

914.

244.

284.

563.

383.

38

S Nakai et al.34


TAB

LE

27.

Cur

rent

stat

usof

com

bine

dus

eof

peri

tone

aldi

alys

is(P

D)

and

othe

rth

erap

ies

for

diff

eren

tpr

imar

ydi

seas

es(f

oral

ldi

alys

ispa

tient

s)

Pri

mar

ydi

seas

e

Cur

rent

stat

usof

com

bine

dus

eof

PD

and

othe

rth

erap

ies

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Non

-PD

PD

only

Non

-PD

+ca

thet

er

PD

+ot

her

ther

apie

s(o

nce

aw

eek)

PD

+ot

her

ther

apie

s(t

wic

ea

wee

k)

PD

+ot

her

ther

apie

s(t

hree

tim

esa

wee

k)

PD

+ot

her

ther

apie

s(o

ther

freq

uenc

y)

Chr

onic

glom

erul

onep

hrit

is81

153

2388

105

611

9121

6984

438

021

564

106

002

(%)

(96.

1)(2

.8)

(0.1

)(0

.7)

(0.1

)(0

.0)

(0.1

)(1

00.0

)C

hron

icpy

elon

ephr

itis

234

183

418

01

02

447

062

23

069

(%)

(95.

7)(3

.4)

(0.2

)(0

.7)

(0.0

)(0

.0)

(0.0

)(1

00.0

)R

apid

lypr

ogre

ssiv

egl

omer

ulon

ephr

itis

150

640

19

20

11

559

040

21

961

(%)

(96.

6)(2

.6)

(0.1

)(0

.6)

(0.1

)(0

.0)

(0.1

)(1

00.0

)N

ephr

opat

hyof

preg

nanc

y/pr

egna

ncy

toxe

mia

133

920

24

30

11

369

038

61

755

(%)

(97.

8)(1

.5)

(0.1

)(0

.3)

(0.2

)(0

.0)

(0.1

)(1

00.0

)O

ther

neph

riti

des

that

cann

otbe

clas

sifie

d97

941

17

20

11

031

028

41

315

(%)

(95.

0)(4

.0)

(0.1

)(0

.7)

(0.2

)(0

.0)

(0.1

)(1

00.0

)Po

lycy

stic

kidn

ey7

409

126

224

60

37

570

01

912

948

2(%

)(9

7.9)

(1.7

)(0

.0)

(0.3

)(0

.1)

(0.0

)(0

.0)

(100

.0)

Nep

hros

cler

osis

1556

360

114

666

53

1625

80

387

620

134

(%)

(95.

7)(3

.7)

(0.1

)(0

.4)

(0.0

)(0

.0)

(0.0

)(1

00.0

)M

alig

nant

hype

rten

sion

165

659

011

10

11

728

045

02

178

(%)

(95.

8)(3

.4)

(0.0

)(0

.6)

(0.1

)(0

.0)

(0.1

)(1

00.0

)D

iabe

tic

neph

ropa

thy

7678

317

1460

282

5820

3278

949

120

090

9904

0(%

)(9

7.3)

(2.2

)(0

.1)

(0.4

)(0

.1)

(0.0

)(0

.0)

(100

.0)

SLE

neph

riti

s1

790

441

70

12

184

50

495

234

0(%

)(9

7.0)

(2.4

)(0

.1)

(0.4

)(0

.0)

(0.1

)(0

.1)

(100

.0)

Am

yloi

dalk

idne

y38

011

01

00

139

30

123

516

(%)

(96.

7)(2

.8)

(0.0

)(0

.3)

(0.0

)(0

.0)

(0.3

)(1

00.0

)G

outy

kidn

ey96

123

08

01

099

30

258

125

1(%

)(9

6.8)

(2.3

)(0

.0)

(0.8

)(0

.0)

(0.1

)(0

.0)

(100

.0)

Ren

alfa

ilure

due

toco

ngen

ital

abno

rmal

ity

ofm

etab

olis

m

192

101

10

00

204

059

263

(%)

(94.

1)(4

.9)

(0.5

)(0

.5)

(0.0

)(0

.0)

(0.0

)(1

00.0

)



TAB

LE

27.

Con

tinue

d

Pri

mar

ydi

seas

e

Cur

rent

stat

usof

com

bine

dus

eof

PD

and

othe

rth

erap

ies

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Non

-PD

PD

only

Non

-PD

+ca

thet

er

PD

+ot

her

ther

apie

s(o

nce

aw

eek)

PD

+ot

her

ther

apie

s(t

wic

ea

wee

k)

PD

+ot

her

ther

apie

s(t

hree

tim

esa

wee

k)

PD

+ot

her

ther

apie

s(o

ther

freq

uenc

y)

Kid

ney

and

urin

ary

trac

ttu

berc

ulos

is25

53

01

00

025

90

7133

0

(%)

(98.

5)(1

.2)

(0.0

)(0

.4)

(0.0

)(0

.0)

(0.0

)(1

00.0

)K

idne

yan

dur

inar

ytr

act

ston

e44

79

02

00

045

80

110

568

(%)

(97.

6)(2

.0)

(0.0

)(0

.4)

(0.0

)(0

.0)

(0.0

)(1

00.0

)K

idne

yan

dur

inar

ytr

act

tum

or55

815

00

00

057

30

155

728

(%)

(97.

4)(2

.6)

(0.0

)(0

.0)

(0.0

)(0

.0)

(0.0

)(1

00.0

)O

bstr

ucti

veur

inar

ytr

act

dise

ase

534

190

11

00

555

013

769

2

(%)

(96.

2)(3

.4)

(0.0

)(0

.2)

(0.2

)(0

.0)

(0.0

)(1

00.0

)M

yelo

ma

169

20

00

00

171

036

207

(%)

(98.

8)(1

.2)

(0.0

)(0

.0)

(0.0

)(0

.0)

(0.0

)(1

00.0

)H

ypop

last

icki

dney

422

460

30

00

471

011

458

5(%

)(8

9.6)

(9.8

)(0

.0)

(0.6

)(0

.0)

(0.0

)(0

.0)

(100

.0)

Und

eter

min

ed16

402

607

1710

617

39

1716

12

466

321

826

(%)

(95.

6)(3

.5)

(0.1

)(0

.6)

(0.1

)(0

.0)

(0.1

)(1

00.0

)R

eint

rodu

ctio

naf

ter

tran

spla

ntat

ion

162

139

212

10

31

678

037

02

048

(%)

(96.

6)(2

.3)

(0.1

)(0

.7)

(0.1

)(0

.0)

(0.2

)(1

00.0

)O

ther

s4

288

120

023

31

24

437

01

186

562

3(%

)(9

6.6)

(2.7

)(0

.0)

(0.5

)(0

.1)

(0.0

)(0

.0)

(100

.0)

Tota

l21

674

860

2021

011

9719

153

128

224

547

357

363

281

913

(%)

(96.

5)(2

.7)

(0.1

)(0

.5)

(0.1

)(0

.0)

(0.1

)(1

00.0

)N

oin

form

atio

nav

aila

ble

372

00

00

039

044

83(%

)(9

4.9)

(5.1

)(0

.0)

(0.0

)(0

.0)

(0.0

)(0

.0)

(100

.0)

Tota

l21

678

560

2221

011

9719

153

128

224

586

357

407

281

996

(%)

(96.

5)(2

.7)

(0.1

)(0

.5)

(0.1

)(0

.0)

(0.1

)(1

00.0

)

S Nakai et al.36


TAB

LE

28.

Pre

dial

ysis

corr

ecte

dse

rum

calc

ium

leve

ls(m

g/dL

)fo

rdi

ffer

ent

dial

ysis

met

hods

(for

all

dial

ysis

patie

nts)

Pre

dial

ysis

corr

ecte

dse

rum

calc

ium

leve

ls(m

g/dL

)

Subt

otal

No

info

rmat

ion

avai

labl

eTo

tal

Mea

nSD

Dia

lysi

sm

etho

d<6

.06.

0~7.

1~8.

4~9.

3~10

.1~

11.1

~12

.0~

Faci

lity

HD

183

752

1967

292

128

7443

428

005

3594

1305

220

073

3373

425

380

79.

290.

88(%

)(0

.1)

(0.3

)(8

.9)

(41.

9)(3

3.8)

(12.

7)(1

.6)

(0.6

)(1

00.0

)H

DF

1038

100

45

285

556

92

511

365

117

1489

91

954

1685

39.

450.

97(%

)(0

.1)

(0.3

)(6

.7)

(35.

5)(3

7.4)

(16.

9)(2

.4)

(0.8

)(1

00.0

)H

F0

010

3040

150

196

6416

09.

370.

77(%

)(0

.0)

(0.0

)(1

0.4)

(31.

3)(4

1.7)

(15.

6)(0

.0)

(1.0

)(1

00.0

)H

emoa

dsor

ptio

n3

792

544

605

326

417

162

516

31

788

9.47

0.83

(%)

(0.2

)(0

.4)

(5.7

)(3

3.5)

(37.

2)(2

0.1)

(2.5

)(0

.4)

(100

.0)

Hom

eH

D0

29

5958

161

114

678

224

9.27

0.83

(%)

(0.0

)(1

.4)

(6.2

)(4

0.4)

(39.

7)(1

1.0)

(0.7

)(0

.7)

(100

.0)

PD

627

335

180

72

460

112

215

751

596

53

199

916

49.

520.

90(%

)(0

.1)

(0.5

)(5

.6)

(30.

3)(4

1.2)

(18.

8)(2

.6)

(0.9

)(1

00.0

)

Tota

l20

282

621

122

9985

383

166

3199

541

5814

8224

280

439

192

281

996

9.31

0.89

(%)

(0.1

)(0

.3)

(8.7

)(4

1.1)

(34.

3)(1

3.2)

(1.7

)(0

.6)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tal

inea

chro

w.H

D,h

emod

ialy

sis;

HD

F,he

mod

iafil

trat

ion;

HF,

hem

ofilt

rati

on;P

D,p

erit

onea

ldi

alys

is.

TAB

LE

29.

Pre

dial

ysis

seru

mph

osph

orus

leve

ls(m

g/dL

)fo

rdi

ffer

ent

dial

ysis

met

hods

(for

all

dial

ysis

patie

nts)

Dia

lysi

sm

etho

d

Pre

dial

ysis

seru

mph

osph

orus

leve

ls(m

g/dL

)

Subt

otal

No

info

rmat

ion

avai

labl

eTo

tal

Mea

nSD

<2.0

2.0~

3.5~

4.8~

6.1~

7.0~

8.0~

9.0~

Faci

lity

HD

1355

2526

276

701

7209

828

706

1390

05

127

3118

226

267

2754

025

380

75.

041.

48(%

)(0

.6)

(11.

2)(3

3.9)

(31.

9)(1

2.7)

(6.1

)(2

.3)

(1.4

)(1

00.0

)H

DF

771

305

462

75

286

216

71

060

392

224

1513

81

715

1685

35.

211.

47(%

)(0

.5)

(8.6

)(3

0.6)

(34.

9)(1

4.3)

(7.0

)(2

.6)

(1.5

)(1

00.0

)H

F2

1922

3510

43

196

6416

04.

841.

49(%

)(2

.1)

(19.

8)(2

2.9)

(36.

5)(1

0.4)

(4.2

)(3

.1)

(1.0

)(1

00.0

)H

emoa

dsor

ptio

n2

117

496

676

243

9218

141

658

130

178

85.

181.

25(%

)(0

.1)

(7.1

)(2

9.9)

(40.

8)(1

4.7)

(5.5

)(1

.1)

(0.8

)(1

00.0

)H

ome

HD

012

6159

122

02

148

7622

44.

841.

10(%

)(0

.0)

(8.1

)(4

1.2)

(39.

9)(8

.1)

(1.4

)(0

.0)

(1.4

)(1

00.0

)P

D22

662

197

72

069

817

366

139

646

116

304

89

164

5.08

1.40

(%)

(0.4

)(1

0.8)

(32.

3)(3

3.8)

(13.

4)(6

.0)

(2.3

)(1

.0)

(100

.0)

Tota

l14

5827

377

8388

480

223

3195

515

424

567

934

2324

942

332

573

281

996

5.05

1.47

(%)

(0.6

)(1

1.0)

(33.

6)(3

2.2)

(12.

8)(6

.2)

(2.3

)(1

.4)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tal

inea

chro

w.H

D,h

emod

ialy

sis;

HD

F,he

mod

iafil

trat

ion;

HF,

hem

ofilt

rati

on;P

D,p

erit

onea

ldi

alys

is.



Calcium carbonate was the most commonly usedamong the phosphate binders (i.e. administered to58.8% of all the target patients). The percentage ofpatients administered calcium carbonate among thepatients who underwent HD at facilities (referred toas facility HD patients) was 58.9%, which was greaterthan the percentage among PD patients (53.3%).Thepercentages of patients exclusively administeredcalcium carbonate, sevelamer HCl, or lanthanum car-bonate were 53.0% for the facility HD patients and48.9% for the PD patients. Namely, these phosphatebinders were more commonly used among the facilityHD patients than among the PD patients. The per-centage of patients administered all of the abovethree phosphate binders was 1.9% for both the facil-ity HD and PD patients; there were no differencesbetween them and the percentages were small. Thepercentages of patients not administered the threephosphate binders were 25.4% for the facility HDpatients and 30.5% for the PD patients. The abovethree phosphate binders were less commonly usedamong the PD patients than among the facility HDpatients.

Table 36 shows the predialysis serum phosphoruslevels in patients administered and not administeredphosphate binders and who underwent HD at facili-ties three times per week. The predialysis serumphosphorus levels recommended in the CKD-MBDGuidelines (1) (3.5–6.0 mg/dL) were satisfied in69.7% of the patients administered only calcium car-bonate, 65.9% of the patients administered only seve-lamer HCl, and 58.8% of the patients administeredonly lanthanum carbonate. Such recommended levelswere also satisfied in 56.0% of the patients adminis-tered all of the above three phosphate binders and63.9% of the non-administered patients. Moreover,20.8% of the non-administered patients showed alow serum phosphorus level of less than 3.5 mg/dL.

Administration or non-administration of vitamin Dand cinacalcet (Tables 37–40)

The percentage of patients administered oralvitamin D among the facility HD patients was 38.2%compared with a higher percentage among PDpatients of 51.9% (Table 37).

On the other hand, the percentage of patientsadministered intravenous vitamin D among the facil-ity HD patients was 26.5% compared with 5.8%among PD patients (Table 38).

The percentage of patients administered cinacalcetshowed an insignificant difference between the facil-ity HD and PD patients (Table 39).

Table 40 shows serum intact-PTH levels in patientsadministered or not administered cinacalcet and who

TAB

LE

30.

Pre

dial

ysis

seru

mm

agne

sium

leve

ls(m

g/dL

)fo

rdi

ffer

ent

dial

ysis

met

hods

(for

all

dial

ysis

patie

nts)

Dia

lysi

sm

etho

d

Pre

dial

ysis

seru

mm

agne

sium

leve

ls(m

g/dL

)

Subt

otal

No

info

rmat

ion

avai

labl

eTo

tal

Mea

nSD

0.1~

0.9~

1.8~

2.7~

3.5~

4.4~

5.2~

6.1~

Faci

lity

HD

3622

6387

072

5580

046

5062

125

023

315

092

510

288

225

380

72.

600.

53(%

)(0

.0)

(1.5

)(5

7.7)

(37.

0)(3

.1)

(0.4

)(0

.2)

(0.2

)(1

00.0

)H

DF

196

571

54

014

277

4013

1310

169

668

416

853

2.62

0.48

(%)

(0.0

)(0

.9)

(56.

2)(3

9.5)

(2.7

)(0

.4)

(0.1

)(0

.1)

(100

.0)

HF

00

1512

21

00

3013

016

02.

620.

62(%

)(0

.0)

(0.0

)(5

0.0)

(40.

0)(6

.7)

(3.3

)(0

.0)

(0.0

)(1

00.0

)H

emoa

dsor

ptio

n0

1872

341

922

21

21

187

601

178

82.

580.

61(%

)(0

.0)

(1.5

)(6

0.9)

(35.

3)(1

.9)

(0.2

)(0

.1)

(0.2

)(1

00.0

)H

ome

HD

01

9520

10

01

118

106

224

2.49

0.82

(%)

(0.0

)(0

.8)

(80.

5)(1

6.9)

(0.8

)(0

.0)

(0.0

)(0

.8)

(100

.0)

PD

034

52

009

527

7715

510

298

86

176

916

42.

350.

92(%

)(0

.0)

(11.

5)(6

7.2)

(17.

6)(2

.6)

(0.5

)(0

.2)

(0.3

)(1

00.0

)

Tota

l37

2723

9562

960

792

5029

679

269

259

165

417

116

579

281

996

2.60

0.54

(%)

(0.0

)(1

.6)

(57.

8)(3

6.8)

(3.0

)(0

.4)

(0.2

)(0

.2)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tal

inea

chro

w.H

D,h

emod

ialy

sis;

HD

F,he

mod

iafil

trat

ion;

HF,

hem

ofilt

rati

on;P

D,p

erit

onea

ldi

alys

is.

S Nakai et al.38


underwent HD at facilities three times per week. Theserum intact-PTH levels in the patients who wereadministered cinacalcet at the time of the survey andthose who had previously received cinacalcet werehigher than those of the patients who had never beenadministered cinacalcet.The serum intact-PTH levelsrecommended in the CKD-MBD Guidelines (61–180 pg/mL) were satisfied in 41.2% of the patientswho currently and previously received cinacalcetcompared with 45.6% among patients who had neverreceived the drug.

Current status of satisfaction of target levels duringtherapy recommended in CKD-MBD Guidelines(Tables 41,42)

Figure 2 shows the target corrected serum calciumand serum phosphorus levels during therapy recom-mended in the CKD-MBD Guidelines (1). Table 41shows the predialysis corrected serum calcium andserum phosphorus levels for all the dialysis patientsto evaluate the current status of satisfaction of levelsrecommended in the CKD-MBD Guidelines. Thepercentage of patients who satisfied both the recom-mended corrected serum calcium and serum phos-phorus levels was 50.6%.

Table 42 shows the current status of satisfaction ofthe values recommended in the CKD-MBD Guide-lines (1) considering the serum intact-PTH level aswell as corrected serum calcium and serum phospho-rus levels. The percentage of patients who satisfiedthe corrected serum calcium, serum phosphorus, andserum intact-PTH levels recommended in the guide-lines was 24.8%

Items associated with dementia

Complications of dementiaThe association between dialysis therapies and the

onset of dementia has not been clearly demonstrated.Previously, there was a time when dialysis encephal-opathy developed owing to the accumulation of alu-minum in the brain of dialysis patients, which wasconsidered to be a serious problem. Because reverseosmosis systems have become widespread, however,dialysis encephalopathy has rarely been observed asa complication of dialysis patients in recent years.Under such circumstances, there have been noreports, as far as we know, in which the relation-ship between dialysis therapies and the onset ofdementia was examined in a large number of dialysispatients.

In the 2009 survey, the onset or non-onset ofdementia was investigated. This item was asked withthe following four alternatives, and the judgment wasleft to respondents.

A Without dementiaB With dementia (requiring no care)C With dementia (requiring care)Z Unspecified

Dialysis method and dementia (Table 43). Patientsdetermined to have dementia (patients with demen-tia) accounted for 9.8% of all the dialysis patients.The percentage of patients with dementia among thepatients who underwent hemofiltration was 20.4%,the highest percentage among different dialysismethods. In contrast, no patients with dementia wereobserved among those who underwent HD at home.

TABLE 31. Tests of serum parathyroid hormone (PTH) level for different dialysis methods (for all dialysis patients)

Dialysis method

Tests of serum parathyroid hormone (PTH) level

UnspecifiedNo information

available Totalintact-PTH whole-PTH HS-PTH Other Subtotal

Facility HD 186 739 20 711 788 1003 209 241 2 44 564 253 807(%) (89.2) (9.9) (0.4) (0.5) (100.0)HDF 12 894 1 238 32 33 14 197 0 2 656 16 853(%) (90.8) (8.7) (0.2) (0.2) (100.0)HF 88 3 0 0 91 0 69 160(%) (96.7) (3.3) (0.0) (0.0) (100.0)Hemoadsorption 1 415 156 11 3 1 585 0 203 1 788(%) (89.3) (9.8) (0.7) (0.2) (100.0)Home HD 139 10 0 0 149 0 75 224(%) (93.3) (6.7) (0.0) (0.0) (100.0)PD 4 775 657 11 63 5 506 2 3 656 9 164(%) (86.7) (11.9) (0.2) (1.1) (100.0)

Total 206 050 22 775 842 1102 230 769 4 51 223 281 996(%) (89.3) (9.9) (0.4) (0.5) (100.0)

The values in parentheses under each figure represent the percentage relative to the total in each row. HD, hemodialysis; HDF,hemodiafiltration; HF, hemofiltration; HS-PTH, high-sensitivity serum parathyroid hormone level; PD, peritoneal dialysis.



TAB

LE

32.

Seru

min

tact

-par

athy

roid

horm

one

(PT

H)

leve

ls(p

g/m

L)

for

diff

eren

tdi

alys

ism

etho

ds(f

oral

ldi

alys

ispa

tient

s)

Dia

lysi

sm

etho

d

Seru

min

tact

-par

athy

roid

horm

one

(PT

H)

leve

ls(p

g/m

L)

Subt

otal

No

info

rmat

ion

avai

labl

eTo

tal

Mea

nSD

<31

31~

61~

121~

181~

361~

721~

1441

~

Faci

lity

HD

1940

022

876

4527

536

236

4368

811

489

180

928

018

105

356

8618

673

916

216

3(%

)(1

0.7)

(12.

6)(2

5.0)

(20.

0)(2

4.1)

(6.3

)(1

.0)

(0.2

)(1

00.0

)H

DF

138

91

427

287

72

505

318

294

516

333

1252

137

312

894

174

186

(%)

(11.

1)(1

1.4)

(23.

0)(2

0.0)

(25.

4)(7

.5)

(1.3

)(0

.3)

(100

.0)

HF

2518

116

195

11

862

8816

132

2(%

)(2

9.1)

(20.

9)(1

2.8)

(7.0

)(2

2.1)

(5.8

)(1

.2)

(1.2

)(1

00.0

)H

emoa

dsor

ptio

n22

314

530

323

736

590

210

138

431

141

516

315

7(%

)(1

6.1)

(10.

5)(2

1.9)

(17.

1)(2

6.4)

(6.5

)(1

.5)

(0.0

)(1

00.0

)H

ome

HD

1114

2830

3617

30

139

013

920

518

4(%

)(7

.9)

(10.

1)(2

0.1)

(21.

6)(2

5.9)

(12.

2)(2

.2)

(0.0

)(1

00.0

)P

D27

638

691

481

61

351

530

110

134

396

379

477

521

721

2(%

)(6

.3)

(8.8

)(2

0.8)

(18.

6)(3

0.7)

(12.

1)(2

.5)

(0.3

)(1

00.0

)

Tota

l21

324

2486

649

408

3983

048

641

1307

62

107

327

199

579

6471

206

050

164

166

(%)

(10.

7)(1

2.5)

(24.

8)(2

0.0)

(24.

4)(6

.6)

(1.1

)(0

.2)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tal

inea

chro

w.H

D,h

emod

ialy

sis;

HD

F,he

mod

iafil

trat

ion;

HF,

hem

ofilt

rati

on;P

D,p

erit

onea

ldi

alys

is.

TAB

LE

33.

Seru

mw

hole

-par

athy

roid

horm

one

(PT

H)

leve

ls(p

q/m

L)

for

diff

eren

tdi

alys

ism

etho

ds(f

oral

ldi

alys

ispa

tient

s)

Dia

lysi

sm

etho

d

Seru

mw

hole

-par

athy

roid

horm

one

(PT

H)

leve

ls(p

q/m

L)

Subt

otal

No

info

rmat

ion

avai

labl

eTo

tal

Mea

nSD

<21

21~

36~

71~

101~

211~

421~

851~

Faci

lity

HD

2448

2373

4784

3143

5418

1706

399

5920

330

381

2071

110

611

5(%

)(1

2.0)

(11.

7)(2

3.5)

(15.

5)(2

6.7)

(8.4

)(2

.0)

(0.3

)(1

00.0

)H

DF

189

138

291

179

298

105

271

122

810

123

810

211

1(%

)(1

5.4)

(11.

2)(2

3.7)

(14.

6)(2

4.3)

(8.6

)(2

.2)

(0.1

)(1

00.0

)H

F1

10

01

00

03

03

5562

(%)

(33.

3)(3

3.3)

(0.0

)(0

.0)

(33.

3)(0

.0)

(0.0

)(0

.0)

(100

.0)

Hem

oads

orpt

ion

2220

3127

3513

40

152

415

610

612

6(%

)(1

4.5)

(13.

2)(2

0.4)

(17.

8)(2

3.0)

(8.6

)(2

.6)

(0.0

)(1

00.0

)H

ome

HD

21

00

60

09

110

201

133

(%)

(22.

2)(1

1.1)

(0.0

)(0

.0)

(66.

7)(0

.0)

(0.0

)(1

00.0

)P

D71

7213

996

160

6618

562

730

657

120

147

(%)

(11.

3)(1

1.5)

(22.

2)(1

5.3)

(25.

5)(1

0.5)

(2.9

)(0

.8)

(100

.0)

Tota

l27

3126

0652

4634

4559

1218

9644

865

2234

942

622

775

106

116

(%)

(12.

2)(1

1.7)

(23.

5)(1

5.4)

(26.

5)(8

.5)

(2.0

)(0

.3)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tal

inea

chro

w.H

D,h

emod

ialy

sis;

HD

F,he

mod

iafil

trat

ion;

HF,

hem

ofilt

rati

on;P

D,p

erit

onea

ldi

alys

is.

S Nakai et al.40


TAB

LE

34.

Pre

dial

ysis

seru

mal

kalin

eph

osph

atas

e(A

LP

)le

vels

(IU

/L)

for

diff

eren

tdi

alys

ism

etho

ds(f

oral

ldi

alys

ispa

tient

s)

Dia

lysi

sm

etho

d

Pre

dial

ysis

seru

mA

LP

leve

ls(I

U/L

)

Subt

otal

No

info

rmat

ion

avai

labl

eTo

tal

Mea

nSD

<71

71~

111~

201~

281~

361~

501~

751~

1001

~15

01~

Faci

lity

HD

786

3022

6871

173

670

3852

723

092

7448

1375

553

267

217

451

3635

625

380

726

514

6(%

)(0

.4)

(1.4

)(3

1.6)

(33.

9)(1

7.7)

(10.

6)(3

.4)

(0.6

)(0

.3)

(0.1

)(1

00.0

)H

DF

3017

34

321

486

52

690

176

463

210

648

2414

653

220

016

853

277

162

(%)

(0.2

)(1

.2)

(29.

5)(3

3.2)

(18.

4)(1

2.0)

(4.3

)(0

.7)

(0.3

)(0

.2)

(100

.0)

HF

328

3316

91

13

9466

160

304

311

(%)

(3.2

)(2

9.8)

(35.

1)(1

7.0)

(9.6

)(1

.1)

(1.1

)(3

.2)

(100

.0)

Hem

oads

orpt

ion

76

253

510

397

305

122

146

11

621

167

178

831

614

7(%

)(0

.4)

(0.4

)(1

5.6)

(31.

5)(2

4.5)

(18.

8)(7

.5)

(0.9

)(0

.4)

(0.1

)(1

00.0

)H

ome

HD

33

4940

319

41

114

183

224

253

134

(%)

(2.1

)(2

.1)

(34.

8)(2

8.4)

(22.

0)(6

.4)

(2.8

)(0

.7)

(0.7

)(1

00.0

)P

D20

391

429

175

397

381

838

384

3310

554

23

622

916

430

117

3(%

)(0

.4)

(0.7

)(2

5.8)

(31.

6)(1

7.6)

(14.

8)(6

.9)

(1.5

)(0

.6)

(0.2

)(1

00.0

)

Tota

l84

632

4674

791

8087

142

634

2599

785

9015

8164

130

523

950

242

494

281

996

267

148

(%)

(0.4

)(1

.4)

(31.

2)(3

3.8)

(17.

8)(1

0.9)

(3.6

)(0

.7)

(0.3

)(0

.1)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tal

inea

chro

w.H

D,h

emod

ialy

sis;

HD

F,he

mod

iafil

trat

ion;

HF,

hem

ofilt

rati

on;P

D,p

erit

onea

ldi

alys

is.

TAB

LE

35.

Use

ofph

osph

ate

bind

ers

for

diff

eren

tdi

alys

ism

etho

ds(f

oral

ldi

alys

ispa

tient

s)

Use

ofph

osph

ate

bind

ers

Dia

lysi

sm

etho

ds

Tota

l(%

)†Fa

cilit

yH

D(%

)†H

DF

(%)†

HF

(%)†

Hem

oads

orpt

ion

(%)†

Hom

eH

D(%

)†P

D(%

)†

Cal

cium

carb

onat

e(C

aCO

3)on

ly82

359

(39.

2)4

859

(34.

6)8

(18.

6)57

4(3

7.2)

57(4

0.7)

2070

(34.

1)89

927

(38.

8)

Seve

lam

erH

Cl

(Sev

elam

er)

only

2018

7(9

.6)

177

1(1

2.6)

2(4

.7)

249

(16.

1)22

(15.

7)66

8(1

1.0)

2289

9(9

.9)

Lan

than

umca

rbon

ate

(La 2

(CO

3)3)

only

884

9(4

.2)

904

(6.4

)1

(2.3

)78

(5.0

)5

(3.6

)22

9(3

.8)

1006

6(4

.3)

CaC

O3

+Se

vela

mer

2757

1(1

3.1)

219

5(1

5.6)

0(0

.0)

264

(17.

1)20

(14.

3)82

0(1

3.5)

3087

0(1

3.3)

CaC

O3

+L

a 2(C

O3)

39

777

(4.7

)88

2(6

.3)

9(2

0.9)

84(5

.4)

4(2

.9)

228

(3.8

)10

984

(4.7

)Se

vela

mer

+L

a 2(C

O3)

33

961

(1.9

)50

1(3

.6)

2(4

.7)

47(3

.0)

2(1

.4)

82(1

.4)

459

5(2

.0)

All

thre

e4

064

(1.9

)39

5(2

.8)

1(2

.3)

26(1

.7)

4(2

.9)

118

(1.9

)4

608

(2.0

)N

one

5332

1(2

5.4)

253

1(1

8.0)

20(4

6.5)

223

(14.

4)26

(18.

6)18

52(3

0.5)

5797

3(2

5.0)

Tota

l21

008

9(1

00.0

)14

038

(100

.0)

43(1

00.0

)15

45(1

00.0

)14

0(1

00.0

)60

67(1

00.0

)23

192

2(1

00.0

)

† Per

cent

age

rela

tive

toto

tali

nea

chco

lum

n.H

D,h

emod

ialy

sis;

HD

F,he

mod

iafil

trat

ion;

HF,

hem

ofilt

rati

on;P

D,p

erit

onea

ldia

lysi

s.



The ratio of the percentage of patients with dementiarequiring no care to that of patients with dementiarequiring care was approximately 1 : 1.

As shown in the following pages, the onset ofdementia is largely affected by age and the complica-tions of diabetes and cerebrovascular disease.Because such background factors in patients werenot considered in the above tabulation results fordifferent dialysis methods, each dialysis methodcannot be associated with the risk of the onset ofdementia. The tabulation results should be inter-preted as indicating the adaptation status of eachdialysis method to patients with dementia.

Gender and dementia (Table 44). Table 44 showsthe numbers of patients with and without dementiawho underwent HD at facilities three times per weekfor both genders. The percentage of patients withdementia was greater among females than males

Age and dementia (Table 45). Table 45 shows thenumbers of patients with and without dementia whounderwent HD at facilities three times per week fordifferent ages. For patients aged 60 years or older, thepercentage of patients with dementia increased withage

Primary diseases and dementia (Table 46).Table 46 shows the numbers of patients with andwithout dementia who underwent HD at facilitiesthree times per week for different primary diseases.The percentage of patients with dementia among thepatients with diabetic nephropathy as the primarydisease (11.6%) was greater than that among thepatients with chronic glomerulonephiritis as the pri-mary disease (7.5%). A study of dementia in thegeneral population,not dialysis patients,also indicatesthat diabetes is related to the onset of dementia (7).

Histories of cerebrovascular disease and dementia(Tables 47,48). Tables 47,48 show the numbers ofpatients with and without dementia who underwentHD at facilities three times per week, and their his-tories of cerebral infarction and cerebral hemor-rhage, respectively. For both cerebral infarction andcerebral hemorrhage, the percentage of patients withdementia was greater in the patients who had histo-ries of these diseases than in the patients who did not.

Activities of daily livingActivities of daily living (ADL) of patients was

previously investigated twice (current status of carein the 1998 survey and physical activities in the 2002survey) (8,9).

TAB

LE

36.

Pre

dial

ysis

seru

mph

osph

orus

leve

ls(m

g/dL

)in

patie

nts

adm

inis

tere

dor

not

adm

inis

tere

dph

osph

ate

bind

ers

(for

patie

nts

who

unde

rwen

tH

Dat

faci

litie

sth

ree

times

per

wee

k)

Use

ofph

osph

ate

bind

ers

Pre

dial

ysis

seru

mph

osph

orus

leve

ls(m

g/dL

)

Subt

otal

No

info

rmat

ion

avai

labl

eTo

tal

<2.0

2.0~

3.5~

4.8~

6.1~

7.0~

8.0~

9.0~

Cal

cium

carb

onat

e(C

aCO

3)on

ly30

48

533

2908

125

359

894

63

920

1247

717

7810

764

178

748

(%)

(0.4

)(1

0.9)

(37.

2)(3

2.5)

(11.

5)(5

.0)

(1.6

)(0

.9)

(100

.0)

Seve

lam

erH

Cl(

Seve

lam

er)

only

351

170

554

07

309

302

61

522

572

332

1950

612

119

627

(%)

(0.2

)(6

.0)

(28.

4)(3

7.5)

(15.

5)(7

.8)

(2.9

)(1

.7)

(100

.0)

Lan

than

umca

rbon

ate

(La 2

(CO

3)3)

only

2053

62

289

268

21

426

887

394

223

845

793

855

0

(%)

(0.2

)(6

.3)

(27.

1)(3

1.7)

(16.

9)(1

0.5)

(4.7

)(2

.6)

(100

.0)

CaC

O3

+Se

vela

mer

571

292

734

19

968

466

22

214

792

460

2678

613

926

925

(%)

(0.2

)(4

.8)

(27.

4)(3

7.2)

(17.

4)(8

.3)

(3.0

)(1

.7)

(100

.0)

CaC

O3

+L

a 2(C

O3)

314

479

259

83

005

163

294

945

926

99

405

499

454

(%)

(0.1

)(5

.1)

(27.

6)(3

2.0)

(17.

4)(1

0.1)

(4.9

)(2

.9)

(100

.0)

Seve

lam

er+

La 2

(CO

3)3

916

999

31

345

695

379

146

104

384

019

385

9(%

)(0

.2)

(4.4

)(2

5.9)

(35.

0)(1

8.1)

(9.9

)(3

.8)

(2.7

)(1

00.0

)A

llth

ree

1014

988

21

317

742

474

196

160

393

011

394

1(%

)(0

.3)

(3.8

)(2

2.4)

(33.

5)(1

8.9)

(12.

1)(5

.0)

(4.1

)(1

00.0

)N

one

712

924

617

956

1265

54

239

192

869

349

147

920

917

4883

7(%

)(1

.5)

(19.

3)(3

7.5)

(26.

4)(8

.8)

(4.0

)(1

.4)

(1.0

)(1

00.0

)

Tota

l11

6121

574

6668

063

640

2536

812

273

4499

2756

197

951

1990

199

941

(%)

(0.6

)(1

0.9)

(33.

7)(3

2.1)

(12.

8)(6

.2)

(2.3

)(1

.4)

(100

.0)

S Nakai et al.42


The tabulation results on ADL are summarized inthis section. Table 49 shows the alternatives used inthe questionnaires and headings in the subsequenttables.

Dementia and ADL (Table 50). Table 50 shows thenumbers of patients with and without dementia whounderwent HD at facilities three times per week fordifferent levels ofADL.There was a tendency that thepercentage of patients with dementia tended to behigher in the group with a low level of ADL

Place of residenceIn this survey, the place of residence of individual

patients was investigated using the following fouralternatives.

A: Patients’ own home (outpatient dialysis, homePD, home HD).

B: Care facilities (e.g. homes with care services,nursing homes such as private-pay nursing homeswithout national aids and nursing homes for familieswith financial difficulties, group homes, vocationalcenters, relief facilities).

TABLE 37. Patients administered or not administered with oral vitamin D for different dialysis methods(for all dialysis patients)

Dialysis method

Use of oral vitamin D

Subtotal Unspecified No information available TotalNonuse Use

Facility HD 131 319 81 113 212 432 1491 39 884 253 807(%) (61.8) (38.2) (100.0)HDF 8 935 5 229 14 164 47 2 642 16 853(%) (63.1) (36.9) (100.0)HF 32 50 82 0 78 160(%) (39.0) (61.0) (100.0)Hemoadsorption 1 004 552 1 556 6 226 1 788(%) (64.5) (35.5) (100.0)Home HD 50 93 143 1 80 224(%) (35.0) (65.0) (100.0)PD 2 966 3 194 6 160 63 2 941 9 164(%) (48.1) (51.9) (100.0)

Total 144 306 90 231 234 537 1608 45 851 281 996(%) (61.5) (38.5) (100.0)

The values in parentheses under each figure represent the percentage relative to the total in each row. HD, hemodialysis; HDF,hemodiafiltration; HF, hemofiltration; PD, peritoneal dialysis.

TABLE 38. Patients administered or not administered intravenous vitamin D for different dialysis methods (for alldialysis patients)

Dialysis method

Use of intravenous vitamin D


available TotalHad never been

administeredUnder

administrationAdministered

previously

Facility HD 140 320 54 135 9 633 204 088 7803 41 916 253 807(%) (68.8) (26.5) (4.7) (100.0)HDF 7 777 4 901 1 041 13 719 518 2 616 16 853(%) (56.7) (35.7) (7.6) (100.0)HF 27 11 2 40 3 117 160(%) (67.5) (27.5) (5.0) (100.0)Hemoadsorption 727 602 152 1 481 64 243 1 788(%) (49.1) (40.6) (10.3) (100.0)Home HD 110 19 8 137 7 80 224(%) (80.3) (13.9) (5.8) (100.0)PD 5 252 327 71 5 650 498 3 016 9 164(%) (93.0) (5.8) (1.3) (100.0)

Total 154 213 59 995 10 907 225 115 8893 47 988 281 996(%) (68.5) (26.7) (4.8) (100.0)




C: Hospitals (e.g. health service facilities forelderly; beds for general patients, patients of chronicstage, patients requiring rehabilitation, and patientswith mental illness and infectious diseases, such astuberculosis).

Z: Unspecified or uncategorized.The place of residence was investigated once in the

1998 survey (living conditions) (8).

Dialysis methods and place of residence(Table 51). Table 51 shows the number of patientsand their places of residence for different dialysismethods. Hemofiltration showed the highest percent-age of patients who stayed at hospitals and care facili-ties, whereas HD at home showed the lowestpercentage of such patients.

ADL and place of residence (Table 52). Table 52shows the number of patients and their places ofresidence who underwent HD at facilities three timesper week for different levels of ADL. The percent-ages of patients who stayed at hospitals and carefacilities tended to be higher among patients with alow level of ADL

Dementia and place of residence (Table 53).Table 53 shows the numbers of patients with andwithout dementia who underwent HD at facilitiesthree times per week and their places of residence.The percentage of patients with dementia was high

among those who stayed at hospitals and carefacilities.

Acknowledgment: We owe the completion of thissurvey to the efforts of the members of the subcommitteeof local cooperation mentioned below and the staffmembers of dialysis facilities who participated in thesurvey and responded to the questionnaires. We wouldlike to express our deepest gratitude to all thesepeople.

District Cooperative Committee: Noritomo Itami,Akishi Momose, Koji Seino, Kazuyuki Suzuki, TomoyoshiKimura, Shigeru Sato, Ikuto Masakane, Minoru Ito, Tsuy-oshi Watanabe, Kunihiro Yamagata, Eiji Kusano, ShigeakiMuto, Hironobu Kawai, Hiromichi Suzuki, Kaoru Tabei,Noriyoshi Muroya, Takahiro Mochizuki, Masanori Abe,Ryoichi Ando, Akira Ishikawa, Kazuyoshi Okada, SatoruKuriyama, Tsutomu Sanaka, Toshio Shinoda, Eisei Noiri,Matsuhiko Hayashi, Sonoo Mizuiri, Koujyu Kamata, ErikoKinugasa, Takatoshi Kakuta, Fumihiko Koiwa, Takeo Sato,Shinichi Nishi, Hiroki Maruyama, Hiroyuki Iida, YoichiIshida, Hitoshi Yokoyama, Chikashi Kito, HaruoYamashita, Mizuya Fukasawa, Kazuhiko Hora, ShigekiSawada, Hiroshi Oda,Akihiko Kato,Yuzo Watanabe,Yasu-hiko Ito, Shinsuke Nomura, Katsunori Sawada, TsuguruHatta, Noriyuki Iwamoto, Masaki Kawamura, YoshiakiTakemoto, Takeshi Nakanishi, Katsunori Yoshida, TakashiShigematsu, Akihisa Nakaoka, Chishio Munemura, Takaf-umi Ito, Makoto Hiramatsu, Noriaki Yorioka, HideyasuMatsuyama, Koichi Uchiyama, Hirofumi Hashimoto,AkiraNumata, Atsumi Harada, Naotami Terao, Kenji Yuasa,Masahiko Nakamoto, Kei Hori, Toru Sanai, TakashiHarada, Kenji Arizono, Tadashi Tomo, Syoichi Fujimoto,Toru Ikeda, Shigeki Toma, Akira Higa, Kunio Yoshihara.

TABLE 39. Patients administered or not administered cinacalcet for different dialysis methods (for all dialysis patients)

Dialysis method

Use of cinacalcet

Subtotal Unspecified

Noinformation

available Total

Had neverbeen

administered

Had beenadministeredfor at leastone year

Had beenadministeredfor less than

one year

Had beenadministered

but discontinued

Facility HD 183 485 14 629 7788 1632 207 534 4282 41 991 253 807(%) (88.4) (7.0) (3.8) (0.8) (100.0)HDF 10 820 1 982 922 184 13 908 242 2 703 16 853(%) (77.8) (14.3) (6.6) (1.3) (100.0)HF 38 4 0 0 42 1 117 160(%) (90.5) (9.5) (0.0) (0.0) (100.0)Hemoadsorption 1 137 260 126 20 1 543 9 236 1 788(%) (73.7) (16.9) (8.2) (1.3) (100.0)Home HD 83 43 15 0 141 3 80 224(%) (58.9) (30.5) (10.6) (0.0) (100.0)PD 5 123 433 245 27 5 828 360 2 976 9 164(%) (87.9) (7.4) (4.2) (0.5) (100.0)

Total 200 686 17 351 9096 1863 228 996 4897 48 103 281 996(%) (87.6) (7.6) (4.0) (0.8) (100.0)


S Nakai et al.44


TAB

LE

40.

Seru

min

tact

-par

athy

roid

horm

one

(PT

H)

leve

ls(p

q/m

L)

inpa

tient

sad

min

iste

red

orno

tad

min

iste

red

cina

calc

et(p

atie

nts

who

unde

rwen

tH

Dat

faci

litie

sth

ree

times

per

wee

k)

Use

ofci

naca

lcet

Seru

min

tact

-PT

Hle

vels

(pq/

mL

)

Subt

otal

No

info

rmat

ion

avai

labl

eTo

tal

Mea

nSD

<31

31~

61~

121~

181~

361~

721~

1441

~

Had

neve

rbe

enad

min

iste

red

1686

519

400

3651

328

167

3239

47

442

1009

146

141

936

3727

145

663

150

147

(%)

(11.

9)(1

3.7)

(25.

7)(1

9.8)

(22.

8)(5

.2)

(0.7

)(0

.1)

(100

.0)

Had

been

adm

inis

tere

dfo

rat

leas

ton

eye

ar25

867

92

617

273

13

924

149

533

455

1209

389

1218

223

221

6(%

)(2

.1)

(5.6

)(2

1.6)

(22.

6)(3

2.4)

(12.

4)(2

.8)

(0.5

)(1

00.0

)H

adbe

enad

min

iste

red

for

less

than

one

year

174

348

119

51

281

225

098

218

531

644

634

648

024

822

3(%

)(2

.7)

(5.4

)(1

8.5)

(19.

9)(3

4.9)

(15.

2)(2

.9)

(0.5

)(1

00.0

)H

adbe

enad

min

iste

red

but

disc

onti

nued

110

105

171

193

398

254

7517

132

35

132

829

234

1(%

)(8

.3)

(7.9

)(1

2.9)

(14.

6)(3

0.1)

(19.

2)(5

.7)

(1.3

)(1

00.0

)Su

btot

al17

407

2053

240

496

3237

238

966

1017

316

0324

916

179

838

5516

565

316

116

2(%

)(1

0.8)

(12.

7)(2

5.0)

(20.

0)(2

4.1)

(6.3

)(1

.0)

(0.2

)(1

00.0

)U

nspe

cifie

d26

730

056

548

452

311

122

32

275

155

243

015

215

6(%

)(1

1.7)

(13.

2)(2

4.8)

(21.

3)(2

3.0)

(4.9

)(1

.0)

(0.1

)(1

00.0

)N

oin

form

atio

nav

aila

ble

819

100

62

108

169

72

296

756

111

158

808

1086

989

417

717

2(%

)(9

.3)

(11.

4)(2

3.9)

(19.

3)(2

6.1)

(8.6

)(1

.3)

(0.2

)(1

00.0

)

Tota

l18

493

2183

843

169

3455

341

785

1104

017

3626

717

288

150

9617

797

716

216

3(%

)(1

0.7)

(12.

6)(2

5.0)

(20.

0)(2

4.2)

(6.4

)(1

.0)

(0.2

)(1

00.0

)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tali

nea

chro

w.

TAB

LE

41.

Pre

dial

ysis

seru

mph

osph

orus

leve

ls(m

g/dL

)in

rela

tion

topr

edia

lysi

sco

rrec

ted

seru

mca

lciu

mle

vels

(mg/

dL)

(for

all

dial

ysis

patie

nts)

Pre

dial

ysis

corr

ecte

dse

rum

calc

ium

leve

ls(m

g/dL

)

Pre

dial

ysis

seru

mph

osph

orus

leve

ls(m

g/dL

)

Subt

otal

No

info

rmat

ion

avai

labl

eTo

tal

Mea

nSD

0.1~

3.5~

6.1~

5.0~

204

914

246

583

822

133

1722

150

5.20

1.61

(0.8

)(5

.9)

(2.4

)(9

.1)

8.4~

2093

912

282

839

158

182

925

9418

301

95.

011.

43(8

.6)

(50.

6)(1

6.1)

(75.

4)

10.1

~5

160

2299

19

458

3760

926

3763

55.

091.

54(2

.1)

(9.5

)(3

.9)

(15.

5)

Subt

otal

2814

816

006

554

454

242

667

137

242

804

5.04

1.47

(11.

6)(6

6.0)

(22.

4)(1

00.0

)N

oin

form

atio

nav

aila

ble

687

404

22

027

675

632

436

3919

25.

371.

63

Tota

l28

835

164

107

5648

124

942

332

573

281

996

5.05

1.47

Mea

n9.

419.

299.

339.

319.

279.

31SD

0.95

0.85

0.96

0.89

1.33

0.89

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tal.



FIG. 2. Target values during therapy recommended in chronic kidney disease-mineral and bone disorder (CKD-MBD) Guidelines.

TABLE 42. Current status of satisfaction of target values of parameters recommended by chronic kidney disease-mineraland bone disorder (CKD-MBD) Guidelines

Extraction conditions Number of patients (%)‡

1) Predialysis serum phosphorus level = 3.5–6.0 mg/dL 128 811 (66.0)2) Predialysis corrected serum calcium level = 8.4–10.0 mg/dL 147 152 (75.4)3) Serum intact-parathyroid hormone (PTH) level = 60–180 pg/mL 88 345 (45.2)4) Predialysis serum phosphorus level = 3.5–6.0 mg/dL and predialysis corrected serum calcium

level = 8.4–10.0 mg/dL98 691 (50.5)

5) Predialysis serum phosphorus level = 3.5–6.0 mg/dL, predialysis corrected serum calciumlevel = 8.4–10.0 mg/dL, and serum intact-parathyroid hormone (PTH) level = 60–180 pg/mL

48 418 (24.8)

Total number of target patients† 195 256 (100.0)

†Target patients refer to those who responded to the questions regarding predialysis phosphorus, predialysis corrected serum calcium, andintact-PTH levels. ‡Percentage relative to total number of target patients†.

S Nakai et al.46


TAB

LE

43.

Num

bers

ofpa

tient

sw

ithan

dw

ithou

tde

men

tiafo

rdi

ffer

ent

dial

ysis

met

hods

(for

all

dial

ysis

patie

nts)

Dia

lysi

sm

etho

d

Dem

enti

a

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Wit

hout

dem

enti

aW

ith

dem

enti

a(r

equi

ring

noca

re)

Wit

hde

men

tia

(req

uiri

ngca

re)

Faci

lity

HD

185

251

9317

1194

420

651

226

2644

669

253

807

(%)

(89.

7)(4

.5)

(5.8

)(1

00.0

)H

DF

1304

141

146

613

918

962

839

1685

3(%

)(9

3.7)

(3.0

)(3

.3)

(100

.0)

HF

357

244

111

516

0(%

)(7

9.5)

(15.

9)(4

.5)

(100

.0)

Hem

oads

orpt

ion

150

916

131

538

724

31

788

(%)

(98.

1)(1

.0)

(0.8

)(1

00.0

)H

ome

HD

144

00

144

080

224

(%)

(100

.0)

(0.0

)(0

.0)

(100

.0)

PD

553

512

519

65

856

116

319

29

164

(%)

(94.

5)(2

.1)

(3.3

)(1

00.0

)

Tota

l20

551

598

7612

621

228

012

2846

5113

828

199

6(%

)(9

0.1)

(4.3

)(5

.5)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tal

inea

chro

w.H

D,h

emod

ialy

sis;

HD

F,he

mod

iafil

trat

ion;

HF,

hem

ofilt

rati

on;P

D,p

erit

onea

ldi

alys

is.

TAB

LE

44.

Num

bers

ofpa

tient

sw

ithan

dw

ithou

tde

men

tiafo

rbo

thge

nder

s(f

orpa

tient

sw

houn

derw

ent

HD

atfa

cilit

ies

thre

etim

espe

rw

eek)

Gen

der

Dem

enti

a

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Wit

hout

dem

enti

aW

ith

dem

enti

a(r

equi

ring

noca

re)

Wit

hde

men

tia

(req

uiri

ngca

re)

Mal

e11

205

549

135

398

122

366

1474

1465

713

849

7(%

)(9

1.6)

(4.0

)(4

.4)

(100

.0)

Fem

ale

6481

537

955

594

7420

498

68

884

8407

4(%

)(8

7.3)

(5.1

)(7

.5)

(100

.0)

Subt

otal

176

870

8708

1099

219

657

024

6023

541

222

571

(%)

(90.

0)(4

.4)

(5.6

)(1

00.0

)N

oin

form

atio

nav

aila

ble

00

00

00

0(%

)

Tota

l17

687

087

0810

992

196

570

2460

2354

122

257

1(%

)(9

0.0)

(4.4

)(5

.6)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tali

nea

chro

w.



TAB

LE

45.

Num

bers

ofpa

tient

sw

ithan

dw

ithou

tde

men

tiaan

dth

eir

ages

(for

patie

nts

who

unde

rwen

tH

Dat

faci

litie

sth

ree

times

per

wee

k)

Age

(yea

rsol

d)

Dem

enti

a

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Wit

hout

dem

enti

aW

ith

dem

enti

a(r

equi

ring

noca

re)

Wit

hde

men

tia

(req

uiri

ngca

re)

<15

41

05

00

5(%

)(8

0.0)

(20.

0)(0

.0)

(100

.0)

15–2

990

57

591

710

112

103

9(%

)(9

8.7)

(0.8

)(0

.5)

(100

.0)

30–4

410

818

3135

1088

490

137

412

348

(%)

(99.

4)(0

.3)

(0.3

)(1

00.0

)45

–59

4169

735

632

842

381

415

511

747

913

(%)

(98.

4)(0

.8)

(0.8

)(1

00.0

)60

–74

8362

629

553

169

8975

011

6810

817

101

735

(%)

(93.

2)(3

.3)

(3.5

)(1

00.0

)75

–89

3854

150

316

801

5037

373

15

872

5697

6(%

)(7

6.5)

(10.

0)(1

3.5)

(100

.0)

90–

127

832

765

32

258

4624

92

553

(%)

(56.

6)(1

4.5)

(28.

9)(1

00.0

)Su

btot

al17

686

987

0810

991

196

568

2460

2354

122

256

9(%

)(9

0.0)

(4.4

)(5

.6)

(100

.0)

No

info

rmat

ion

avai

labl

e1

01

20

02

(%)

(50.

0)(0

.0)

(50.

0)(1

00.0

)

Tota

l17

687

087

0810

992

196

570

2460

2354

122

257

1(%

)(9

0.0)

(4.4

)(5

.6)

(100

.0)

Mea

n64

.80

75.9

277

.48

66.0

068

.26

65.7

966

.00

SD12

.25

8.97

8.88

12.4

911

.99

12.4

712

.49

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tali

nea

chro

w.

S Nakai et al.48


TAB

LE

46.

Num

bers

ofpa

tient

sw

ithan

dw

ithou

tde

men

tiaan

dth

eir

prim

ary

dise

ases

(for

patie

nts

who

unde

rwen

tH

Dat

faci

litie

sth

ree

times

per

wee

k)

Pri

mar

ydi

seas

e

Dem

enti

a

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Wit

hout

dem

enti

aW

ith

dem

enti

a(r

equi

ring

noca

re)

Wit

hde

men

tia

(req

uiri

ngca

re)

Chr

onic

glom

erul

onep

hrit

is66

683

2444

294

972

076

755

858

481

415

(%)

(92.

5)(3

.4)

(4.1

)(1

00.0

)C

hron

icpy

elon

ephr

itis

193

875

842

097

2522

62

348

(%)

(92.

4)(3

.6)

(4.0

)(1

00.0

)R

apid

lypr

ogre

ssiv

egl

omer

ulon

ephr

itis

119

160

791

330

1615

41

500

(%)

(89.

5)(4

.5)

(5.9

)(1

00.0

)N

ephr

opat

hyof

preg

nanc

y/pr

egna

ncy

toxe

mia

113

523

201

178

1316

11

352

(%)

(96.

3)(2

.0)

(1.7

)(1

00.0

)O

ther

neph

riti

des

that

cann

otbe

clas

sifie

d79

430

3585

917

134

101

0(%

)(9

2.4)

(3.5

)(4

.1)

(100

.0)

Poly

cyst

icki

dney

634

617

118

36

700

7779

97

576

(%)

(94.

7)(2

.6)

(2.7

)(1

00.0

)N

ephr

oscl

eros

is11

890

1010

134

614

246

173

162

116

040

(%)

(83.

5)(7

.1)

(9.4

)(1

00.0

)M

alig

nant

hype

rten

sion

140

452

671

523

1118

21

716

(%)

(92.

2)(3

.4)

(4.4

)(1

00.0

)D

iabe

tic

neph

ropa

thy

6339

136

934

640

7172

492

88

365

8101

7(%

)(8

8.4)

(5.1

)(6

.5)

(100

.0)

SLE

neph

riti

s1

478

4051

156

911

172

175

2(%

)(9

4.2)

(2.5

)(3

.3)

(100

.0)

Am

yloi

dalk

idne

y32

313

1034

65

4239

3(%

)(9

3.4)

(3.8

)(2

.9)

(100

.0)

Gou

tyki

dney

817

3537

889

1210

11

002

(%)

(91.

9)(3

.9)

(4.2

)(1

00.0

)R

enal

failu

redu

eto

cong

enit

alab

norm

alit

yof

met

abol

ism

173

30

176

126

203

(%)

(98.

3)(1

.7)

(0.0

)(1

00.0

)K

idne

yan

dur

inar

ytr

act

tube

rcul

osis

203

1814

235

030

265

(%)

(86.

4)(7

.7)

(6.0

)(1

00.0

)K

idne

yan

dur

inar

ytr

act

ston

e37

016

1640

27

4245

1(%

)(9

2.0)

(4.0

)(4

.0)

(100

.0)

Kid

ney

and

urin

ary

trac

ttu

mor

460

2623

509

468

581

(%)

(90.

4)(5

.1)

(4.5

)(1

00.0

)O

bstr

ucti

veur

inar

ytr

act

dise

ase

415

1419

448

347

498

(%)

(92.

6)(3

.1)

(4.2

)(1

00.0

)M

yelo

ma

122

126

140

113

154

(%)

(87.

1)(8

.6)

(4.3

)(1

00.0

)H

ypop

last

icki

dney

348

64

358

449

411

(%)

(97.

2)(1

.7)

(1.1

)(1

00.0

)U

ndet

erm

ined

1277

478

81

173

1473

529

52

040

1707

0(%

)(8

6.7)

(5.3

)(8

.0)

(100

.0)

Rei

ntro

duct

ion

afte

rtr

ansp

lant

atio

n1

239

2025

128

442

156

148

2(%

)(9

6.5)

(1.6

)(1

.9)

(100

.0)

Oth

ers

336

215

921

13

732

6048

54

277

((%

))(9

0.1)

(4.3

)(5

.7)

(100

.0)

Subt

otal

176

856

8708

1099

219

655

624

6023

497

222

513

(%)

(90.

0)(4

.4)

(5.6

)(1

00.0

)N

oin

form

atio

nav

aila

ble

140

014

044

58(%

)(1

00.0

)(0

.0)

(0.0

)(1

00.0

)To

tal

176

870

8708

1099

219

657

024

6023

541

222

571

(%)

(90.

0)(4

.4)

(5.6

)(1

00.0

)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tali

nea

chro

w.S

LE

,sys

tem

iclu

pus

eryt

hem

atos

us.



TAB

LE

47.

Num

bers

ofpa

tient

sw

ithan

dw

ithou

tde

men

tiaan

dth

eir

hist

ory

ofce

rebr

alin

farc

tion

(for

patie

nts

who

unde

rwen

tH

Dat

faci

litie

sth

ree

times

per

wee

k)

His

tory

ofce

rebr

alin

farc

tion

Dem

enti

a

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Wit

hout

dem

enti

aW

ith

dem

enti

a(r

equi

ring

noca

re)

Wit

hde

men

tia

(req

uiri

ngca

re)

No

147

989

5582

617

315

974

497

31

599

162

316

(%)

(92.

6)(3

.5)

(3.9

)(1

00.0

)Y

es18

073

2227

359

323

893

482

593

2496

8(%

)(7

5.6)

(9.3

)(1

5.0)

(100

.0)

Acu

te,U

nder

trea

tmen

t81

1724

122

45

131

(%)

(66.

4)(1

3.9)

(19.

7)(1

00.0

)W

ith

lacu

nar

infa

rcti

on2

726

333

464

352

321

693

613

(%)

(77.

4)(9

.5)

(13.

2)(1

00.0

)Su

btot

al16

886

981

5910

254

187

282

1480

226

619

102

8(%

)(9

0.2)

(4.4

)(5

.5)

(100

.0)

Uns

peci

fied

857

9917

51

131

268

41

403

(%)

(75.

8)(8

.8)

(15.

5)(1

00.0

)N

oin

form

atio

nav

aila

ble

714

445

056

38

157

712

2127

130

140

(%)

(87.

6)(5

.5)

(6.9

)(1

00.0

)

Tota

l17

687

087

0810

992

196

570

2460

2354

122

257

1(%

)(9

0.0)

(4.4

)(5

.6)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tali

nea

chro

w.

TAB

LE

48.

Num

bers

ofpa

tient

sw

ithan

dw

ithou

tde

men

tiaan

dth

eir

hist

ory

ofce

rebr

alhe

mor

rhag

e(f

orpa

tient

sw

houn

derw

ent

HD

atfa

cilit

ies

thre

etim

espe

rw

eek)

His

tory

ofce

rebr

alhe

mor

rhag

e

Dem

enti

a

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Wit

hout

dem

enti

aW

ith

dem

enti

a(r

equi

ring

noca

re)

Wit

hde

men

tia

(req

uiri

ngca

re)

No

162

322

7513

909

517

893

011

681

742

181

840

(%)

(90.

7)(4

.2)

(5.1

)(1

00.0

)Y

es6

857

656

115

08

663

271

219

915

3(%

)(7

9.2)

(7.6

)(1

3.3)

(100

.0)

Acu

te,U

nder

trea

tmen

t58

515

7810

593

(%)

(74.

4)(6

.4)

(19.

2)(1

00.0

)Su

btot

al16

923

781

7410

260

187

671

1449

196

619

108

6(%

)(9

0.2)

(4.4

)(5

.5)

(100

.0)

Uns

peci

fied

518

6112

770

626

44

974

(%)

(73.

4)(8

.6)

(18.

0)(1

00.0

)N

oin

form

atio

nav

aila

ble

711

547

360

58

193

747

2157

130

511

(%)

(86.

8)(5

.8)

(7.4

)(1

00.0

)

Tota

l17

687

087

0810

992

196

570

2460

2354

122

257

1(%

)(9

0.0)

(4.4

)(5

.6)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tth

epe

rcen

tage

rela

tive

toth

eto

tali

nea

chro

w.

S Nakai et al.50


TABLE 49. Alternatives used in questionnaire on activities of daily living (ADL) and headings in table

Alternatives used in questionnaire Headings in table

A: The patient can perform social activities without symptoms and behave as he/she was before the onsetof the diseases without restrictions.

→ No symptoms

B: The patient has moderate symptoms and has trouble with physical work, but can walk and do lightand sedentary work, such as light domestic and clerical work.

→ Moderatesymptoms

C: The patient can walk and take care of him/herself, but sometimes requires care. The patient can sit upat least half of the day although he/she cannot do light work.

→ �50% sittingup

D: The patient can take care of him/herself to some extent, but often requires care and is in bed at leasthalf of the day.

→ �50% in bed

E: The patient cannot take care of him/herself and has to be in bed the whole day, requiring constantcare.

→ Whole dayin bed

Z: Unspecified or uncategorized → Unspecified

TABLE 50. Numbers of patients with and without dementia and their levels of activities of daily living (ADL)(for patients who underwent HD at facilities three times per week)

Activities of daily living

Dementia


available TotalWithoutdementia

With dementia(requiring no care)

With dementia(requiring care)

No symptoms 86 258 813 301 87 372 177 617 88 166(%) (98.7) (0.9) (0.3) (100.0)Moderate symptoms 53 988 1967 638 56 593 137 812 57 542(%) (95.4) (3.5) (1.1) (100.0)�50(%) sitting up 19 647 2926 2 331 24 904 188 311 25 403(%) (78.9) (11.7) (9.4) (100.0)�50(%) in bed 8 908 1705 2 876 13 489 136 121 13 746(%) (66.0) (12.6) (21.3) (100.0)Whole day in bed 4 492 1153 4 649 10 294 537 138 10 969(%) (43.6) (11.2) (45.2) (100.0)Subtotal 173 293 8564 10 795 192 652 1175 1 999 195 826(%) (90.0) (4.4) (5.6) (100.0)Unspecified 684 34 85 803 1272 7 2 082(%) (85.2) (4.2) (10.6) (100.0)No information available 2 893 110 112 3 115 13 21 535 24 663(%) (92.9) (3.5) (3.6) (100.0)

Total 176 870 8708 10 992 196 570 2460 23 541 222 571(%) (90.0) (4.4) (5.6) (100.0)

The values in parentheses under each figure represent the percentage relative to the total in each row.

TABLE 51. Places of residence for different dialysis methods (for all dialysis patients)

Dialysis method

Places of residence


available TotalHomes† Care facilities‡ Hospitals§

Facility HD 186 469 4308 17 945 208 722 1385 43 700 253 807(%) (89.3) (2.1) (8.6) (100.0)HDF 13 161 164 701 14 026 51 2 776 16 853(%) (93.8) (1.2) (5.0) (100.0)HF 30 3 7 40 1 119 160(%) (75.0) (7.5) (17.5) (100.0)Hemoadsorption 1 484 11 38 1 533 16 239 1 788(%) (96.8) (0.7) (2.5) (100.0)Home HD 144 0 1 145 0 79 224(%) (99.3) (0.0) (0.7) (100.0)PD 5 645 35 232 5 912 91 3 161 9 164(%) (95.5) (0.6) (3.9) (100.0)

Total 206 933 4521 18 924 230 378 1544 50 074 281 996(%) (89.8) (2.0) (8.2) (100.0)

The values in parentheses under each figure represent the percentage relative to the total in each row. †Patients’ own home (outpatientdialysis, home PD, home HD). ‡Care facilities (e.g. homes with care services, nursing homes such as private-pay nursing homes withoutnational aids and nursing homes for families with financial difficulties, group homes, vocational centers, relief facilities). §Hospitals (e.g.health service facilities for elderly; beds for general patients, patients of chronic stage, patients requiring rehabilitation, and patients withmental illness and infectious diseases, such as tuberculosis).



TAB

LE

52.

AD

Lfo

rdi

ffer

ent

plac

esof

resi

denc

e(f

orpa

tient

sw

houn

derw

ent

HD

atfa

cilit

ies

thre

etim

espe

rw

eek)

Pla

ces

ofre

side

nce

Act

ivit

ies

ofda

ilyliv

ing

(AD

L)

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

No

sym

ptom

sM

oder

ate

sym

ptom

s�

50%

sitt

ing

up�

50%

inbe

dW

hole

day

inbe

d

Hom

es†

8680

355

435

2105

28

292

326

417

484

674

32

390

177

979

(%)

(49.

6)(3

1.7)

(12.

0)(4

.7)

(1.9

)(1

00.0

)C

are

faci

litie

s‡41

556

31

141

988

814

392

134

494

004

(%)

(10.

6)(1

4.4)

(29.

1)(2

5.2)

(20.

8)(1

00.0

)H

ospi

tals

§63

31

275

308

44

403

684

816

243

188

176

1660

7(%

)(3

.9)

(7.8

)(1

9.0)

(27.

1)(4

2.2)

(100

.0)

Subt

otal

8785

157

273

2527

713

683

1092

619

501

096

52

615

198

590

(%)

(45.

0)(2

9.4)

(13.

0)(7

.0)

(5.6

)(1

00.0

)U

nspe

cifie

d15

012

1216

1020

011

151

131

6(%

)(7

5.0)

(6.0

)(6

.0)

(8.0

)(5

.0)

(100

.0)

No

info

rmat

ion

avai

labl

e16

525

711

447

3361

62

2204

722

665

(%)

(26.

8)(4

1.7)

(18.

5)(7

.6)

(5.4

)(1

00.0

)

Tota

l88

166

5754

225

403

1374

610

969

195

826

2082

2466

322

257

1(%

)(4

5.0)

(29.

4)(1

3.0)

(7.0

)(5

.6)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tthe

perc

enta

gere

lati

veto

the

tota

lin

each

row

.† Pat

ient

s’ow

nho

me

(out

pati

entd

ialy

sis,

hom

epe

rito

neal

dial

ysis

[PD

],ho

me

HD

).‡ C

are

faci

litie

s(e

.g.h

omes

wit

hca

rese

rvic

es,n

ursi

ngho

mes

such

aspr

ivat

e-pa

ynu

rsin

gho

mes

wit

hout

nati

onal

aids

and

nurs

ing

hom

esfo

rfa

mili

esw

ith

finan

cial

diffi

cult

ies,

grou

pho

mes

,vo

cati

onal

cent

ers,

relie

ffac

iliti

es).

§ Hos

pita

ls(e

.g.h

ealt

hse

rvic

efa

cilit

ies

for

elde

rly;

beds

for

gene

ralp

atie

nts,

pati

ents

ofch

roni

cst

age,

pati

ents

requ

irin

gre

habi

litat

ion,

and

pati

ents

wit

hm

enta

lilln

ess

and

infe

ctio

usdi

seas

es,s

uch

astu

berc

ulos

is).

TAB

LE

53.

Num

bers

ofpa

tient

sw

ithan

dw

ithou

tde

men

tiaan

dth

eir

plac

esof

resi

denc

e(f

orpa

tient

sw

houn

derw

ent

HD

atfa

cilit

ies

thre

etim

espe

rw

eek)

Pla

ces

ofre

side

nce

Dem

enti

a

Subt

otal

Uns

peci

fied

No

info

rmat

ion

avai

labl

eTo

tal

Wit

hout

dem

enti

aW

ith

dem

enti

a(r

equi

ring

noca

re)

Wit

hde

men

tia

(req

uiri

ngca

re)

Hom

es†

163

408

6050

518

817

464

665

62

677

177

979

(%)

(93.

6)(3

.5)

(3.0

)(1

00.0

)C

are

faci

litie

s‡2

213

533

114

23

888

6452

400

4(%

)(5

6.9)

(13.

7)(2

9.4)

(100

.0)

Hos

pita

ls§

912

220

114

574

1570

763

626

416

607

(%)

(58.

1)(1

2.8)

(29.

1)(1

00.0

)Su

btot

al17

474

385

9410

904

194

241

1356

299

319

859

0(%

)(9

0.0)

(4.4

)(5

.6)

(100

.0)

Uns

peci

fied

200

412

216

1100

01

316

(%)

(92.

6)(1

.9)

(5.6

)(1

00.0

)N

oin

form

atio

nav

aila

ble

192

711

076

211

34

2054

822

665

(%)

(91.

2)(5

.2)

(3.6

)(1

00.0

)

Tota

l17

687

087

0810

992

196

570

2460

2354

122

257

1(%

)(9

0.0)

(4.4

)(5

.6)

(100

.0)

The

valu

esin

pare

nthe

ses

unde

rea

chfig

ure

repr

esen

tthe

perc

enta

gere

lati

veto

the

tota

lin

each

row

.† Pat

ient

s’ow

nho

me

(out

pati

entd

ialy

sis,

hom

epe

rito

neal

dial

ysis

[PD

],ho

me

HD

).‡ C

are

faci

litie

s(e

.g.h

omes

wit

hca

rese

rvic

es,n

ursi

ngho

mes

such

aspr

ivat

e-pa

ynu

rsin

gho

mes

wit

hout

nati

onal

aids

and

nurs

ing

hom

esfo

rfa

mili

esw

ith

finan

cial

diffi

cult

ies,

grou

pho

mes

,vo

cati

onal

cent

ers,

relie

ffac

iliti

es).

§ Hos

pita

ls(e

.g.h

ealt

hse

rvic

efa

cilit

ies

for

elde

rly;

beds

for

gene

ralp

atie

nts,

pati

ents

ofch

roni

cst

age,

pati

ents

requ

irin

gre

habi

litat

ion,

and

pati

ents

wit

hm

enta

lilln

ess

and

infe

ctio

usdi

seas

es,s

uch

astu

berc

ulos

is).

S Nakai et al.52


REFERENCES

1. Guideline Working Group, Japanese Society for DialysisTherapy. Clinical practice guideline for the management of sec-ondary hyperparathyroidism in chronic dialysis patients. TherApher Dial 2008;12:514–25.

2. Cutler SJ, Ederer F. Maximum utilization of the life tablemethod in analyzing survival. J Chronic Dis 1958;8:699–712.

3. Kawanishi H, Akiba T, Masakane I et al. Standard on micro-biological management of fluids for hemodialysis and relatedtherapies by the Japanese Society for Dialysis Therapy 2008.Ther Apher Dial 2009;13:161–6.

4. Nakai S, Suzuki K, Masakane I et al. Overview of regular dialy-sis treatment in Japan (as of 31 December 2008). Ther ApherDial 2010;14:505–40.

5. Nakai S, Masakane I, Akiba T et al. Overview of regular dialysistreatment in Japan as of 31 December 2006. Ther Apher Dial2008;12:428–56.

6. Nakai S, Masakane I, Shigematsu T et al. An overview ofregular dialysis treatment in Japan (as of 31 December 2007).Ther Apher Dial 2009;13:457–504.

7. Kopf D, Frölich L. Risk of incident Alzheimer’s disease in dia-betic patients: a systematic review of prospective trials. J Alzhe-imers Dis 2009;16:677–85.

8. Patient Registration Committee, Japanese Society for DialysisTherapy. An overview of dialysis treatment in Japan (as of Dec.31, 1998). J Jpn Soc Dial Ther 2000;33:1–27.

9. Patient Registration Committee, Japanese Society for DialysisTherapy. An overview of regular dialysis treatment in Japan (asof 31 December 2002). Ther Apher Dial 2004;8:358–82.



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