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Keywords:

  • Combined use;
  • Peritoneal dialysis;
  • Dementia;
  • Dialysis;
  • Patient population;
  • Survey;
  • Survival rate

Abstract

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES

A nationwide statistical survey of 4196 dialysis facilities was conducted at the end of 2009, and 4133 facilities (98.5%) responded. The number of patients undergoing dialysis at the end of 2009 was determined to be 290 661, an increase of 7240 patients (2.6%) compared with that of 2008. The number of dialysis patients per million at the end of 2009 was 2279.5. The crude death rate of dialysis patients from the end of 2008 to the end of 2009 was 9.6%. The mean age of the new patients introduced into dialysis was 67.3 years old and the mean age of the entire dialysis patient population was 65.8 years old. Primary diseases such as diabetic nephropathy and chronic glomerulonephritis for new dialysis patients, showed a percentage of 44.5% and 21.9%, respectively. Based on the facilities surveyed, 84.2% of the facilities that responded to the questionnaire satisfied the microbiological quality standard for dialysis 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 the facilities surveyed satisfied another standard of the society of a bacterial count of less than 100 cfu/mL in the dialysis fluid. The facility survey indicated that the number of patients who were treated by blood purification by both peritoneal dialysis and extracorporeal circulation, such as hemodialysis, was 1720. Among the total number of patients, 24.8% were satisfied with the management target recommended in the treatment guidelines for secondary hyperparathyroidism. These standards are set by the JSDT, based on the three parameters, i.e. serum calcium concentration, serum phosphorus concentration, and serum intact parathyroid hormone concentration. According to the questionnaire, 9.8% of the patients were considered to have a complication of dementia.

The Japanese Society for Dialysis Therapy (JSDT) has been conducting a statistical survey of dialysis facilities across the country annually since 1968. In this survey, conducted at the end of 2009, new members were added to the District Cooperative Committee to implement the survey, which includes a registry of patients who undergo peritoneal dialysis (PD), i.e. the PD registry. Facilities that offer only PD were excluded from the previous survey but were included as targets of this survey. The purpose of this inclusion was to clarify the current status of PD therapy in Japan more accurately than before. JSDT called the facilities that offer only PD in advance and confirmed whether they had PD patients as of the end of 2009. Then, questionnaires were sent only to facilities that were confirmed to have PD patients as of the end of 2009. As a result, the number of facilities that participated in the 2009 survey was 4196, an increase of 72 facilities from 2008 (4124 facilities). This increase in the number of target facilities was the largest in the last few years.

The following items were newly added to the 2009 survey. First, the facility and patient surveys included, for the first time, a detailed investigation of the current status of patients who underwent both PD and other therapies such as hemodialysis (HD) and hemodiafiltration (HDF). As guidelines for the treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD), JSDT released “Clinical practice guideline for the management of secondary hyperparathyroidism in chronic dialysis patients.” in 2008 (1). These guidelines are currently being revised. The data required for this revision were also newly investigated in the 2009 survey. Moreover, the dialysis population is aging yearly in Japan. In line with this background, dementia in dialysis patients is becoming a serious problem. With the aim of obtaining basic data required to cope with this problem, the current status of dialysis patients who have dementia as a complication was also surveyed. In addition to this, the activities of daily living (ADL) and place of residence of individual patients were surveyed again.

Similar to the 2008 survey, JSDT received candidate research topics from its regular members, among which five were selected for open recruitment research projects. The verification of the database of JSDT (database cleaning) started in 2004 and was ongoing in 2009.

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

  • A. 
    Basic demographics
  • B. 
    Current status of dialysis fluid quality
  • C. 
    Current status of PD therapy
  • D. 
    Items associated with CKD-MBD
  • E. 
    Items associated with dementia

Since our previous reports, we have received various questions and critical comments about our statistical surveys from JSDT members. The common comments and frequently asked questions include the following: (i) Is it necessary to conduct such surveys that require troublesome work? (ii) There are too many survey items. (iii) Why are the survey items changed every year? (iv) Disclosure of survey items in advance is preferable. (v) Is it effective to conduct the survey every year? The Committee of JSDT has answered each question as much as possible. Answers to these questions were given by Yoshiharu Tsubakihara, Chair of the Committee, as indicated below.

Is it necessary to conduct such surveys that require troublesome work?

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES

In Article 4 (Objectives and Tasks) Chapter 2 of the Memorandum of JSDT, it is stated that this society shall conduct research surveys on dialysis therapies, that is, blood purification therapies (e.g. HD, PD, hemofiltration, hemoadsorption, and plasma exchange) and the causes and clinical conditions of diseases treated by dialysis. Research on dialysis therapies will be promoted and information will be disseminated through the presentation of survey results, exchange of findings, and provision of information, thereby contributing to academic progress of dialysis therapy in Japan. Therefore, the implementation of statistical surveys is one objective of JSDT and one of the most important tasks. We conduct statistical surveys not because it is stated that such surveys shall be conducted in the Memorandum but because we believe that they are important. We consider that the discontinuation of our statistical surveys will lead to the loss of the direction of dialysis care in Japan.

There are too many survey items

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES

This is related to question (iii). The items of our surveys are selected annually to satisfy various requirements, such as acquiring necessary information for the preparation of guidelines. As shown in paper 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 total number of survey items.

Why are the survey items changed every year?

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES

The needs for survey items are changing every year. Survey items are determined in accordance with the changing needs. The number of items is appropriately controlled so that it does not continue to increase.

Disclosure of survey items in advance is preferable

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES

It is very difficult to determine the survey items 2 years before the survey. To inform dialysis facilities about the determined survey items as early as possible, information on survey items is published in the journals published by JSDT in October, and it is also sent by fax to individual facilities.

Is it effective to conduct the survey every year?

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES

We believe that our annual statistical survey is of great significance. For example, when this regular survey is carried out every other year, the motivation of surveyed facilities to respond to the questionnaires may decrease and lead to a decrease in the collection rate. We believe that this survey has a high collection rate because it is carried out annually.

However, we also recognize that complaints about this survey from the society members may come from insufficient feedback of the survey and analysis results to the members who cooperated in this survey. To deal with this problem, we publish, on the JSDT homepage, this annual rapid report of survey results, i.e. “The Illustrated, Current Status of Chronic Dialysis in Japan,” (reports since 2002 are available). Individual facilities are provided with only one printed copy. Moreover, we are devoting ourselves to the preparation of a CD-ROM that contains detailed data, which every member can use to search necessary information. We have received many proposals for open recruitment research projects started 2 years before. The results of accepted open recruitment research projects and research carried out by the Committee have been presented and appreciated at many conferences in Japan as well as the US and European countries. In addition, findings of this survey are used as the basis for the preparation of guidelines and contribute to the improvement of dialysis care in Japan.

PATIENTS AND METHODS

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES

This survey is conducted every year by sending questionnaires to target dialysis facilities. A total of 4196 facilities surveyed were either member facilities of JSDT, nonmember facilities offering chronic HD, or facilities offering PD but not HD as of 31 December 2009. The number of facilities participating in this survey increased by 72 (1.7%) from the previous year.

The questionnaires were mainly sent and collected by postal mail; some were also faxed. Paper questionnaires and electronic media, i.e. universal serial bus (USB) memory drives, were sent to all the 4196 target facilities, 3352 of which responded using the USB memory drives.

In this survey, we used two sets of questionnaires. One was about the facilities (facility survey), in which items related to the details of dialysis facilities were investigated, such as the number of patients, the number of staff members, and the number of patient stations at individual facilities (using the questionnaire referred to as “Sheet I”). The other survey was about the patients (patient survey), in which the epidemiological background, treatment conditions, and outcome of treatment of individual dialysis patients were examined (using the questionnaires referred to as “Sheets II, III, and IV”).

The collection rate of the questionnaire (Sheet I) in the 2009 survey was 98.5% (4133 facilities), which exceeded the goal of at least 98%. Moreover, the collection rate of both questionnaires, i.e. the facility and patient surveys, from facilities was 96.0% (4029 facilities), which also exceeded the goal of at least 95%.

As mentioned above, the number of facilities that responded 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 that responded using electronic media contributes to the accurate and simple analysis of survey data.

The cumulative survival rates after introduction into dialysis were calculated using the mortality table method (2).

Additional survey items

In the 2009 survey, the following items were added to the facility survey.

  • • 
    Number of bedside consoles equipped with endotoxin 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 concentration 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 peritoneal cleaning) among those who underwent daytime dialysis, nighttime dialysis, or home HD
  • • 
    Number of patients who underwent both PD and other blood purification therapies using extracorporeal circulation such as HD and HDF
  • • 
    Number of new patients who were started on PD within the survey period but introduced to other blood purification therapies within the same period

In the patient survey, the following items were investigated in addition to the basic survey items, such as, epidemiological background and patient outcomes.

  • • 
    Current status of combined use of PD and other blood purification therapies using extracorporeal circulation such as HD and HDF
  • • 
    Number of years on PD (PD period) (for patients who were receiving PD at the time of survey)
  • • 
    Number of times of undergoing blood purification therapy per week (frequency of dialysis per week)
  • • 
    Duration of one session of blood purification using extracorporeal 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 lanthanum carbonate drug
  • • 
    Administration or nonadministration of other phosphate binders
  • • 
    Administration or nonadministration of oral vitamin D supplements
  • • 
    Administration or nonadministration of intravenous vitamin D supplements
  • • 
    Administration or nonadministration of cinacalcet
  • • 
    History of undergoing parathyroidectomy (PTx)
  • • 
    History of undergoing percutaneous ethanol injection 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

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES

Basic demographics

Number of patients

Table 1 shows a summary of the dynamics of the dialysis patient population in Japan at the end of 2009 obtained in this survey. Data on the number of years on dialysis (dialysis period) and the longest period on dialysis were obtained from the patient survey. All the other results were obtained from the facility survey.

Table 1. Current status of chronic dialysis therapy in Japan (as of 31 December 2009)
Number of facilities4 133Increase of 52 (1.3%)  
  1. 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 agree with the total number of patients counted according to the method of treatment. The number of dialysis patients was calculated from questionnaire sheets II to IV.

EquipmentNumber of patient station114 979Increase of 2 981 (2.7%)  
CapacitySimultaneous dialysis (people)113 487Increase of 2 889 (2.6%)  
Maximum accommodation capacity (people)383 530Increase of 8 748 (2.3%)  
Chronic dialysis patients290 661Increase of 7 240 (2.6%)  
 Daytime dialysis238 848(82.2%)   
Nighttime dialysis41 719(14.4%)   
Home dialysis236(0.1%)   
Peritoneal dialysis9 858(3.4%)   
Number of patients who underwent PD with HD, HDF, etc.1 720(0.6%)   
Patients per million2 279.5Increase of 59.9 (2.7%)  
Number of patients newly introduced to dialysis37 566Decrease of 614 (1.6%)  
Number of decreased patients27 646Increase of 380 (1.4%)  
(The above data were obtained from the facility survey.)
Duration of dialysisMaleFemaleUnknownTotal
0 ≤ < 588 60348 3310136 934 (48.6%)
5 ≤ < 1043 91527 336071 251 (25.3%)
10 ≤ < 1520 64214 432035 074 (12.4%)
15 ≤ < 2010 0988 013018 111 (6.4%)
20 ≤ < 255 3394 53709 876 (3.5%)
25≤5 8994 851010 750 (3.8%)
Total174 496107 5000281 996 (100.0%)
Longest dialysis history41 years and 8 months  

The total number of dialysis patients in Japan at the end of 2009 was 290 661, as determined from the facility survey. The number of dialysis patients in Japan at the end of 2008 was 283 421, an increase of 7240 patients (2.6%) from the end of 2008 to the end of 2009.

The number of facilities that responded to the questionnaire at the end of 2009 was 4133, an increase of 52 (1.3%) from the previous year. The number of bedside consoles at the end of 2009 was 114 979, an increase of 2981 (2.7%) from the previous year. The total number of patients for whom dialysis can be simultaneously provided at all the facilities was 113 487 and the maximum dialysis capacity was 383 530 patients, both of which increased in 2009.

The percentage of patients who underwent daytime dialysis increased slightly to 82.2%, whereas patients who underwent nighttime dialysis decreased further to 14.4%. The trends of increasing percentage of daytime dialysis patients and decreasing percentage of nighttime dialysis patients were continuously observed over the last 10 years. The number of patients who underwent home HD was 236, an increase of 43 (22.3%) from the previous year, but it was still a small number of patients.

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

According to the patient survey, the longest period on dialysis was 41 years and 8 months. The number of dialysis patients per million at the end of 2009 was 2279.5. Table 2 shows changes in the number of dialysis patients per million. Table 3 shows the total number of chronic dialysis patients in each prefecture of Japan determined from the facility survey.

Table 2. Changes in number of dialysis patients per million
YearNumber of patients per millionYearNumber of patients per million
  1. Tabulated results of facility survey. 1989: The collection rate was 86% and the obtained data were rounded off to the second decimal place.

1983443.719971394.9
1984497.519981472.5
1985547.819991556.7
1986604.420001624.1
1987658.820011721.9
1988721.120021801.2
1989790.020031862.7
1990835.720041943.5
1991937.620052017.6
1992995.820062069.9
19931076.420072154.2
19941149.420082219.6
19951229.720092279.5
19961328.4  
Table 3. Numbers of chronic dialysis patients in prefectures
Names of administrative divisionsDaytimeNighttimeHome hemodialysisPeritoneal dialysisTotal
  1. The number of dialysis patients was calculated based on facility survey data. The total number of chronic dialysis patients is the total in the column for the number of patients in sheet I, and does not necessarily agree with the total number of patients counted in accordance with the method of dialysis.

Hokkaido12 3521 3471452114 234
Aomori prefecture2 82025401023 176
Iwate prefecture2 41133101322 874
Miyagi prefecture3 8018720724 745
Akita prefecture1 6231500681 841
Yamagata prefecture1 96725721322 358
Fukushima prefecture4 01147102164 698
Ibaraki prefecture5 79387511546 823
Tochigi prefecture4 5287422525 324
Gunma prefecture4 2297560925 077
Saitama prefecture12 1701 8664139114 468
Chiba prefecture10 3521 813127612 442
Tokyo22 1994 9816101128 197
Kanagawa prefecture13 7863 0912052017 417
Niigata prefecture3 5631 00411604 728
Toyama prefecture1 9132631792 256
Ishikawa prefecture1 9993270932 419
Fukui prefecture1 5021730801 755
Yamanashi prefecture1 8642011602 126
Nagano prefecture3 68573611334 555
Gifu prefecture3 38963651414 171
Shizuoka prefecture7 6141 38142629 261
Aichi prefecture12 0753 1693362315 900
Mie prefecture3 16961031253 907
Shiga prefecture2 106420131192 658
Kyoto prefecture4 5311 04722555 835
Osaka prefecture17 3992 8753966420 977
Hyogo prefecture9 9611 6641730411 946
Nara prefecture2 72823451003 067
Wakayama prefecture2 4352601312 727
Tottori prefecture1 0981280941 320
Shimane prefecture1 1701470971 414
Okayama prefecture3 60646702614 334
Hiroshima prefecture5 89255754886 942
Yamaguchi prefecture2 79336301513 307
Tokushima prefecture2 06527501772 517
Kagawa prefecture2 06316062412 470
Ehime prefecture2 83342011503 404
Kochi prefecture1 8922360412 169
Fukuoka prefecture10 1892 377452113 091
Saga prefecture1 7582711142 044
Nagasaki prefecture3 07245931633 697
Kumamoto prefecture4 70098201415 823
Oita prefecture3 20433811353 678
Miyazaki prefecture3 0075390463 592
Kagoshima prefecture4 1896082984 897
Okinawa prefecture3 3425860724 000
Total238 84841 7192369858290 661
Mean age

The dialysis patient population in Japan is aging yearly. Table 4 shows changes in mean age of patients obtained from the patient survey. As shown in this table, the mean age of new patients who were started on dialysis in 2009 was 67.3 years (±13.3, ±SD here and hereafter) and the mean age of all the dialysis patients in 2009 was 65.8 years (±12.6). The dialysis patient population aged by 6.8 years from the end of 1989 to the end of 1999 and by 5.2 years from the end of 1999 to the end of 2009. Thus, the rate of aging of the dialysis patient population decreased. Similarly, the mean age of new patients who were started on dialysis increased by 6.0 years from the end of 1989 to the end of 1999, but by only 3.9 years from the end of 1999 to the end of 2009. These findings show that the rate of aging of new patients who were started on dialysis also decreased.

Table 4. Changes in mean ages of new patients started on dialysis and of patients at the end of each year
 Age of patients newly introduced into dialysis treatment (years)Age of patients at the end of each year (years)
YearMean±SDMean±SD
198351.915.548.313.8
198453.215.349.213.8
198554.415.450.313.7
198655.115.251.113.6
198755.914.952.113.7
198856.914.952.913.6
198957.414.753.813.5
199058.114.654.513.5
199158.114.655.313.5
199259.514.556.013.5
199359.814.456.613.5
199460.414.357.313.5
199561.014.258.013.4
199661.514.258.613.4
199762.214.059.213.4
199862.713.959.913.3
199963.413.960.613.3
200063.813.961.213.2
200164.213.761.613.1
200264.713.662.213.0
200365.413.562.812.9
200465.813.463.312.9
200566.213.463.912.8
200666.413.464.412.8
200766.813.364.912.7
200867.213.365.312.7
200967.313.365.812.6

Tables 5,6 show the gender and age distributions of new patients who were started on dialysis and all dialysis patients in 2009, respectively. Tables 7,8 show the summaries of the primary diseases of new patients who were started on dialysis and the dialysis patients in 2009, respectively. The data in these tables were obtained from the patient survey.

Table 5. Number of new patients started on dialysis in 2009 for different ages and both genders
Age of the patients when newly introduced into dialysis (years)Male(%)Female(%)Subtotal(%)No information availableTotal(%)
  • The values in parentheses on the right side of each figure represent the percentage relative to the total in each column.

<58(0.0)9(0.1)17(0.0) 17(0.0)
5–96(0.0)0(0.0)6(0.0) 6(0.0)
10–147(0.0)4(0.0)11(0.0) 11(0.0)
15–1924(0.1)18(0.1)42(0.1) 42(0.1)
20–2453(0.2)23(0.2)76(0.2) 76(0.2)
25–29103(0.4)52(0.4)155(0.4) 155(0.4)
30–34249(1.0)114(0.9)363(1.0) 363(1.0)
35–39493(2.0)227(1.8)720(1.9) 720(1.9)
40–44683(2.8)300(2.3)983(2.6) 983(2.6)
45–491 028(4.2)409(3.2)1 437(3.9) 1 437(3.9)
50–541 426(5.9)601(4.7)2 027(5.5) 2 027(5.5)
55–592 423(9.9)1 032(8.1)3 455(9.3) 3 455(9.3)
60–643 254(13.4)1 384(10.8)4 638(12.5) 4 638(12.5)
65–693 600(14.8)1 627(12.7)5 227(14.1) 5 227(14.1)
70–743 656(15.0)1 883(14.7)5 539(14.9) 5 539(14.9)
75–793 639(14.9)2 048(16.0)5 687(15.3) 5 687(15.3)
80–842 565(10.5)1 766(13.8)4 331(11.6) 4 331(11.6)
85–89943(3.9)1 022(8.0)1 965(5.3) 1 965(5.3)
90–94185(0.8)250(2.0)435(1.2) 435(1.2)
95≦23(0.1)46(0.4)69(0.2) 69(0.2)
Total24 368(100.0)12 815(100.0)37 183(100.0) 37 183(100.0)
No information available65 39 104  104 
Total24 433 12 854 37 287  37 287 
Mean66.37 69.08 67.31  67.31 
SD13.04 13.61 13.30  13.30 
Table 6. Number of all dialysis patients in 2009 for different ages and both genders
Age (years)Male(%)Female(%)Subtotal(%)No information availableTotal(%)
  • The values in parentheses on the right side of each figure represent the percentage relative to the total in each column.

<524(0.0)21(0.0)45(0.0) 45(0.0)
5–916(0.0)15(0.0)31(0.0) 31(0.0)
10–1422(0.0)10(0.0)32(0.0) 32(0.0)
15–1962(0.0)45(0.0)107(0.0) 107(0.0)
20–24246(0.1)126(0.1)372(0.1) 372(0.1)
25–29626(0.4)348(0.3)974(0.3) 974(0.3)
30–341 620(0.9)822(0.8)2 442(0.9) 2 442(0.9)
35–393 513(2.0)1 732(1.6)5 245(1.9) 5 245(1.9)
40–445 684(3.3)2 791(2.6)8 475(3.0) 8 475(3.0)
45–498 090(4.6)4 125(3.8)12 215(4.3) 12 215(4.3)
50–5411 869(6.8)6 448(6.0)18 317(6.5) 18 317(6.5)
55–5920 209(11.6)11 348(10.6)31 557(11.2) 31 557(11.2)
60–6427 690(15.9)15 292(14.2)42 982(15.2) 42 982(15.2)
65–6927 776(15.9)16 156(15.0)43 932(15.6) 43 932(15.6)
70–7425 503(14.6)15 670(14.6)41 173(14.6) 41 173(14.6)
75–7921 589(12.4)14 016(13.0)35 605(12.6) 35 605(12.6)
80–8413 482(7.7)10 865(10.1)24 347(8.6) 24 347(8.6)
85–895 063(2.9)5 764(5.4)10 827(3.8) 10 827(3.8)
90–941 237(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)
Total174 488(100.0)107 491(100.0)281 979(100.0) 281 979(100.0)
No information available8 9 17  17 
Total174 496 107 500 281 996  281 996 
Mean65.00 67.00 65.76  65.76 
SD12.45 12.83 12.63  12.63 
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 ageSD
  1. The values in parentheses under each figure represent the percentage relative to the total in each column. The column “No information on birth date” shows the number of patients who provided no date of birth, such that the calculation of age was impossible. SLE, systemic lupus erythematosus.

Chronic glomerulonephritis8 117(21.9)38(36.5)8 155(21.9)66.9114.52
Chronic pyelonephritis261(0.7)1(1.0)262(0.7)67.8513.93
Rapidly progressive glomerulonephritis456(1.2)2(1.9)458(1.2)70.4213.00
Nephropathy of pregnancy/pregnancy toxemia45(0.1)0(0.0)45(0.1)59.5113.47
Other nephritides that cannot be classified172(0.5)1(1.0)173(0.5)64.6017.89
Polycystic kidney847(2.3)5(4.8)852(2.3)61.4612.38
Nephrosclerosis3 970(10.7)9(8.7)3 979(10.7)74.0611.33
Malignant hypertension287(0.8)2(1.9)289(0.8)63.7516.85
Diabetic nephropathy16 524(44.5)25(24.0)16 549(44.5)65.6611.65
SLE nephritis272(0.7)0(0.0)272(0.7)60.4315.90
Amyloidal kidney144(0.4)0(0.0)144(0.4)66.9011.76
Gouty kidney86(0.2)0(0.0)86(0.2)64.5312.84
Renal failure due to congenital abnormality of metabolism25(0.1)0(0.0)25(0.1)46.3220.60
Kidney and urinary tract tuberculosis14(0.0)0(0.0)14(0.0)69.3610.42
Kidney and urinary tract stone62(0.2)0(0.0)62(0.2)69.6810.74
Kidney and urinary tract tumor156(0.4)1(1.0)157(0.4)70.9012.51
Obstructive urinary tract disease96(0.3)0(0.0)96(0.3)64.8918.06
Myeloma140(0.4)0(0.0)140(0.4)71.2110.19
Hypoplastic kidney52(0.1)2(1.9)54(0.1)39.7328.15
Undetermined3 963(10.7)13(12.5)3 976(10.7)70.8913.20
Reintroduction after transplantation199(0.5)1(1.0)200(0.5)54.6516.22
Others1 223(3.3)4(3.8)1 227(3.3)67.3415.95
Total37 111(100.0)104(100.0)37 215(100.0)67.3013.31
No information available72   72 70.9211.31
Total37 183 104 37 287 67.3113.30
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 ageSD
  1. The values in parentheses under each figure represent the percentage relative to the total in each column. The column “No information on birth date” shows the number of patients who provided no date of birth, such that the calculation of age was impossible. SLE, systemic lupus erythematosus.

Chronic glomerulonephritis106 000(37.6)2(11.8)106 002(37.6)64.5112.75
Chronic pyelonephritis3 069(1.1)0(0.0)3 069(1.1)63.7414.23
Rapidly progressive glomerulonephritis1 961(0.7)0(0.0)1 961(0.7)66.2013.85
Nephropathy of pregnancy/pregnancy toxemia1 755(0.6)0(0.0)1 755(0.6)61.109.87
Other nephritides that cannot be classified1 315(0.5)0(0.0)1 315(0.5)59.2916.98
Polycystic kidney9 482(3.4)0(0.0)9 482(3.4)63.5411.03
Nephrosclerosis20 131(7.1)3(17.6)20 134(7.1)73.2711.88
Malignant hypertension2 177(0.8)1(5.9)2 178(0.8)63.1914.61
Diabetic nephropathy99 032(35.1)8(47.1)99 040(35.1)66.2411.03
SLE nephritis2 340(0.8)0(0.0)2 340(0.8)58.2613.75
Amyloidal kidney516(0.2)0(0.0)516(0.2)65.9711.24
Gouty kidney1 251(0.4)0(0.0)1 251(0.4)66.3711.69
Renal failure due to congenital abnormality of metabolism263(0.1)0(0.0)263(0.1)48.6816.89
Kidney and urinary tract tuberculosis330(0.1)0(0.0)330(0.1)70.529.42
Kidney and urinary tract stone568(0.2)0(0.0)568(0.2)69.2911.41
Kidney and urinary tract tumor727(0.3)1(5.9)728(0.3)70.3811.89
Obstructive urinary tract disease692(0.2)0(0.0)692(0.2)60.9018.22
Myeloma207(0.1)0(0.0)207(0.1)70.3410.95
Hypoplastic kidney585(0.2)0(0.0)585(0.2)41.3019.66
Undetermined21 824(7.7)2(11.8)21 826(7.7)68.1013.39
Reintroduction after transplantation2 048(0.7)0(0.0)2 048(0.7)54.2212.76
Others5 623(2.0)0(0.0)5 623(2.0)63.5016.16
Total281 896(100.0)17(100.0)281 913(100.0)65.7612.63
No information available83   83 68.4712.16
Total281 979 17 281 996 65.7612.63
Primary disease of new patients who were started on dialysis

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

Table 9 shows changes in the percentage of new patients who were started on dialysis each year with various primary causes of renal failure (primary diseases). The percentage of patients with diabetic nephropathy as the primary disease among the new patients who were started on dialysis continued to increase and reached 44.5% in 2009. The percentage of patients with chronic glomerulonephritis, which is currently the second most common primary disease, has declined annually as has the absolute number of such patients. The percentage of patients with “unspecified” primary diseases was the third highest (10.7%). In relation to the aging of new dialysis patients, the percentage of patients with nephrosclerosis continued to increase and reached 10.7%. The percentages of patients with polycystic kidney disease, rapidly progressive glomerulonephritis, systemic lupus erythematosus (SLE) nephritis, and chronic pyelonephritis as the primary diseases were nearly the same as in previous years

Table 9. Changes in percentage of new patients started on dialysis for each year with various primary diseases
Year19831984198519861987198819891990199119921993199419951996
  1. SLE, systemic lupus erythematosus.

Diabetic nephropathy15.617.419.621.322.124.326.526.228.128.429.930.731.933.1
Chronic glomerulonephritis60.558.756.054.854.249.947.446.144.242.241.440.539.438.9
Nephrosclerosis3.03.33.53.73.93.94.15.45.55.96.26.16.36.4
Polycystic kidney2.82.83.12.93.23.13.12.93.02.72.62.52.42.5
Rapidly progressive glomerulonephritis0.90.70.91.00.80.90.80.70.60.70.80.80.80.8
SLE nephritis1.11.11.11.20.90.91.01.11.31.31.21.21.11.3
Chronic pyelonephritis2.42.22.12.01.81.81.51.51.71.61.11.41.21.1
Undetermined4.44.04.84.24.13.84.03.33.73.73.33.94.55.0
Year1997199819992000200120022003200420052006200720082009 
Diabetic nephropathy33.935.736.236.638.139.141.041.342.042.943.443.344.5 
Chronic glomerulonephritis36.635.033.632.532.431.929.128.127.425.623.822.821.9 
Nephrosclerosis6.86.77.07.67.67.88.58.89.09.410.010.610.7 
Polycystic kidney2.42.42.22.42.32.42.32.72.32.42.32.52.3 
Rapidly progressive glomerulonephritis1.10.90.91.01.01.11.21.11.11.21.31.21.2 
SLE nephritis1.01.11.20.91.00.90.70.80.80.80.80.80.7 
Chronic pyelonephritis1.21.11.11.01.10.91.00.91.00.80.80.70.7 
Undetermined5.55.66.17.69.08.48.89.39.59.910.210.610.7 

Table 10 shows changes in the percentages of all dialysis patients at the end of each year with various primary diseases. Among all dialysis patients, chronic glomerulonephritis was still the most common primary disease. However, there was a clear decrease in the percentage of patients with this primary disease. In contrast, the percentage of patients with diabetic nephropathy among all dialysis patients continuously increased. The percentages of patients with chronic glomerulonephritis and diabetic nephropathy at the end of 2009 were 37.6 and 35.1%, respectively, a difference of 2.5 points. If the above trends continue, diabetic nephropathy will become the most common primary disease among all dialysis patients in a few years, similar to the trend among new dialysis patients. The primary diseases with the third and fourth highest percentages of patients among all dialysis patients in 2009 were unspecified primary diseases (7.7%) and nephrosclerosis (7.1%), respectively. The percentage of patients with nephrosclerosis among all dialysis patients was also increasing. The percentages of patients with polycystic kidney disease, chronic pyelonephritis, SLE nephritis, and rapidly progressive glomerulonephritis as the primary diseases were nearly the same as those in previous years.

Table 10. Changes in percentage of all the dialysis patients at the end of each year with various primary diseases
Year19831984198519861987198819891990199119921993199419951996
  1. SLE, systemic lupus erythematosus.

Chronic glomerulonephritis74.572.172.370.669.467.965.964.161.760.458.857.756.655.4
Diabetic nephropathy7.48.49.410.511.712.814.014.916.417.118.219.220.421.6
Nephrosclerosis1.51.71.92.02.12.12.32.62.93.13.43.63.84.0
Polycystic kidney2.72.93.03.13.13.23.23.33.33.33.33.23.23.2
Chronic pyelonephritis3.13.32.62.42.42.32.22.22.12.01.91.81.71.6
SLE nephritis0.80.80.90.90.90.90.91.01.11.11.11.11.11.1
Rapidly progressive glomerulonephritis0.50.40.50.50.50.50.50.50.50.50.50.50.50.5
Undetermined2.22.32.32.52.62.52.62.62.92.92.93.13.23.6
Year1997199819992000200120022003200420052006200720082009 
Chronic glomerulonephritis54.152.551.149.749.648.246.645.143.642.240.439.037.6 
Diabetic nephropathy22.724.025.126.027.228.129.230.231.432.333.434.235.1 
Nephrosclerosis4.24.44.54.85.05.15.35.75.96.26.56.87.1 
Polycystic kidney3.23.23.23.23.33.33.33.43.33.43.43.43.4 
Chronic pyelonephritis1.61.51.51.41.41.31.31.31.21.21.21.11.1 
SLE nephritis1.11.11.11.01.01.00.90.90.90.90.90.80.8 
Rapidly progressive glomerulonephritis0.60.60.60.60.60.60.60.60.60.60.70.70.7 
Undetermined3.94.24.45.05.65.96.36.46.67.07.47.67.7 
Causes of death

Table 11 shows the classification of the causes of death of new patients who were started on dialysis in 2009 and who died by the end of 2009. Table 12 shows the classification of the causes of death of all the dialysis patients who died in 2009. Table 13 shows changes in the percentages of the leading causes of death in all dialysis patients. Since the 2003 survey,the classification of the causes of death was changed to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).

Table 11. Classification of causes of death of new patients who were started on dialysis and died in 2009
Cause of deathMale(%)Female(%)Total(%)No information availableTotal(%)
  1. The values in parentheses under each figure represent the percentage relative to the total in each column.

Cardiac failure413(20.8)254(23.5)667(21.8)0667(21.8)
Cerebrovascular disease105(5.3)60(5.5)165(5.4)0165(5.4)
Infectious disease535(27.0)266(24.6)801(26.1)0801(26.1)
Hemorrhage44(2.2)30(2.8)74(2.4)074(2.4)
Malignant tumor219(11.0)101(9.3)320(10.4)0320(10.4)
Cachexia/Uremia57(2.9)31(2.9)88(2.9)088(2.9)
Cardiac infarction71(3.6)36(3.3)107(3.5)0107(3.5)
Potassium poisoning/Moribund57(2.9)30(2.8)87(2.8)087(2.8)
Chronic hepatitis/Cirrhosis41(2.1)16(1.5)57(1.9)057(1.9)
Encephalopathy6(0.3)3(0.3)9(0.3)09(0.3)
Suicide/Refusal of treatment24(1.2)11(1.0)35(1.1)035(1.1)
Intestinal obstruction22(1.1)7(0.6)29(0.9)029(0.9)
Lung thrombus/Pulmonary embolus7(0.4)4(0.4)11(0.4)011(0.4)
Death due to disaster7(0.4)4(0.4)11(0.4)011(0.4)
Others220(11.1)119(11.0)339(11.1)0339(11.1)
Undetermined154(7.8)110(10.2)264(8.6)0264(8.6)
Total1982(100.0)1082(100.0)3064(100.0)03064(100.0)
No information available7 3 10  10 
Total1989 1085 3074 03074 
Table 12. Classification of causes of death of patients who died in 2009
Cause of deathMale(%)Female(%)Total(%)No information availableTotal(%)
  1. The values in parentheses under each figure represent the percentage relative to the total in each column.

Cardiac failure3 639(22.1)2447(26.4)6 086(23.6)06 086(23.6)
Cerebrovascular disease1 348(8.2)812(8.8)2 160(8.4)02 160(8.4)
Infectious disease3 476(21.1)1859(20.1)5 335(20.7)05 335(20.7)
Hemorrhage296(1.8)195(2.1)491(1.9)0491(1.9)
Malignant tumor1 761(10.7)650(7.0)2 411(9.4)02 411(9.4)
Cachexia/Uremia428(2.6)264(2.9)692(2.7)0692(2.7)
Cardiac infarction717(4.3)324(3.5)1 041(4.0)01 041(4.0)
Potassium poisoning/Moribund774(4.7)413(4.5)1 187(4.6)01 187(4.6)
Chronic hepatitis/Cirrhosis218(1.3)82(0.9)300(1.2)0300(1.2)
Encephalopathy23(0.1)9(0.1)32(0.1)032(0.1)
Suicide/Refusal of treatment171(1.0)69(0.7)240(0.9)0240(0.9)
Intestinal obstruction138(0.8)101(1.1)239(0.9)0239(0.9)
Lung thrombus/Pulmonary embolus45(0.3)21(0.2)66(0.3)066(0.3)
Death due to disaster117(0.7)41(0.4)158(0.6)0158(0.6)
Others1 534(9.3)1050(11.3)2 584(10.0)02 584(10.0)
Undetermined1 799(10.9)921(9.9)2 720(10.6)02 720(10.6)
Total16 484(100.0)9258(100.0)25 742(100.0)025 742(100.0)
No information available46 25 71 071 
Total16 530 9283 25 813 025 813 
Table 13. Annual changes in major causes of death
Year19831984198519861987198819891990199119921993199419951996
Cardiac failure30.330.531.333.232.736.533.430.430.531.129.928.225.424.1
Infectious disease11.011.511.512.012.012.211.711.612.111.312.212.613.814.6
Malignant tumor7.76.96.46.95.86.97.68.27.67.17.47.37.27.7
Cerebrovascular disease14.215.414.214.014.212.913.213.913.713.613.514.113.512.9
Cardiac infarction5.34.85.36.16.05.45.35.85.85.85.77.17.57.4
Others5.14.95.74.75.24.84.44.64.44.54.14.55.86.3
Unspecified1.92.02.82.22.41.61.92.11.82.52.62.83.22.5
Year1997199819992000200120022003200420052006200720082009 
Cardiac failure23.924.124.323.225.525.125.025.125.824.924.023.723.6 
Infectious disease14.915.016.316.616.315.918.518.819.219.918.919.920.7 
Malignant tumor8.17.77.68.38.58.58.59.09.09.29.29.29.4 
Cerebrovascular disease12.612.111.311.311.611.210.710.69.89.48.98.68.4 
Cardiac infarction8.47.97.47.07.47.46.25.45.14.44.44.14.0 
Others6.77.07.77.99.19.09.710.39.19.59.79.710.0 
Unspecified3.53.93.68.15.76.65.66.57.38.310.310.910.6 

Similar to the results in 2008, the leading cause of death of new patients who were started on dialysis in 2009 was infectious diseases (26.1%). The second, third, fourth, and fifth leading causes were cardiac failure (21.8%), malignant tumors (10.4%), cerebrovascular disease (5.4%), and cardiac infarction (5.4%), respectively. The trend of increasing percentage of patients who died of infectious diseases was continuously observed in the last 20 years. In contrast, the percentage of patients who died of cardiac failure has gradually decreased. The percentage of patients who died of malignant tumors has remained steady at approximately 10% in recent years. The yearly percentages of patients who died of cerebrovascular disease and cardiac infarction decreased over the last 10 years.

Among all dialysis patients, the leading cause of death was cardiac failure; the percentage of patients who died of cardiac failure was 23.6% in 2009. The percentage of patients who died of cardiac failure among all dialysis patients markedly decreased in the 1990s and remained at nearly 23–26% thereafter. The percentage of patients who died of infectious diseases among all dialysis patients was 20.7% in 2009 and has tended to gradually increase in the last 20 years. In contrast, the percentage of patients who died of cerebrovascular disease steadily decreased and reached 8.4% in 2009. The percentage of patients who died of cardiac infarction also gradually decreased from the peak of 8.4% in 1997 to 4.0% in 2009. The percentage of patients who died of malignant tumors tended to increase slightly and reached 9.4% in 2009.

Annual crude death rate

The annual crude death rate was calculated from the facility survey data. It shows the percentage of patients who died in a given year with respect to the mean annual number of dialysis patients. The annual crude death rate in 2009 was 9.6%. Table 14 shows the trend of annual crude death rates since 1983. It is expected that the annual crude death rate will increase because of the increase in the number of patients with a poor prognosis, such as older patients who were started on dialysis and patients with diabetic nephropathy and nephrosclerosis. However, the annual crude death rate has remained at approximately 9.5% since 1992.

Table 14. Change in annual crude death rate
YearCrude death rate (%)YearCrude death rate (%)
19839.019979.4
19848.919989.2
19859.119999.7
19869.020009.2
19878.520019.3
19889.220029.2
19897.920039.3
19909.620049.4
19918.920059.5
19929.720069.2
19939.420079.4
19949.520089.8
19959.720099.6
19969.4  
Cumulative survival rate of new patients who were started on dialysis for each year

The cumulative survival rates of new patients who were 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 patients who were started on dialysis were extracted from the table and plotted in Figure 1.

Table 15. Cumulative survival rates of new patients started on dialysis since 1983
Year of introductionNumber of patients1-year survival rate2-year survival rate3-year survival rate4-year survival rate5-year survival rate6-year survival rate7-year survival rate8-year survival rate9-year survival rate10-year survival rate11-year survival rate12-year survival rate13-year survival rate14-year survival rate15-year survival rate16-year survival rate17-year survival rate18-year survival rate19-year survival rate20-year survival rate21-year survival rate22-year survival rate23-year survival rate24-year survival rate25-year survival rate26-year survival rate
19839 8890.8190.7470.6820.6330.5890.5560.5230.4850.4560.4250.3960.3720.3480.3290.3070.2880.2720.2550.2410.2260.2140.2000.1890.1790.1670.156
198410 7130.8170.7350.6710.6200.5770.5380.4980.4650.4350.4070.3780.3530.3290.3080.2880.2710.2530.2390.2260.2120.1980.1880.1790.1670.158 
198511 6290.7950.7200.6600.6090.5630.5200.4850.4440.4130.3850.3610.3360.3110.2890.2710.2530.2360.2210.2080.1920.1790.1680.1560.147  
198612 6330.7990.7250.6670.6190.5660.5210.4800.4450.4080.3790.3520.3280.3050.2840.2670.2500.2340.2210.2090.1960.1830.1730.162   
198713 5670.8150.7380.6710.6070.5560.5070.4620.4260.3930.3640.3380.3140.2930.2710.2530.2380.2200.2030.1900.1800.1700.159    
198814 7790.8250.7410.6670.6030.5480.4990.4560.4190.3840.3530.3260.3030.2810.2600.2420.2250.2110.1960.1860.1740.161     
198914 5720.8490.7610.6870.6180.5610.5120.4660.4270.3920.3600.3340.3090.2870.2660.2490.2320.2170.2030.1920.179      
199016 5220.8390.7490.6740.6100.5550.5010.4590.4190.3840.3530.3250.3000.2780.2600.2430.2270.2110.1950.182       
199118 2270.8280.7350.6620.5980.5390.4880.4450.4070.3750.3450.3180.2930.2730.2540.2370.2210.2060.193        
199219 9180.8220.7280.6520.5890.5320.4830.4390.4010.3680.3410.3150.2910.2710.2500.2320.2160.201         
199320 8960.8330.7430.6670.5990.5430.4910.4470.4080.3750.3450.3180.2940.2700.2520.2350.218          
199421 4410.8300.7440.6700.6040.5450.4930.4500.4120.3760.3450.3150.2930.2710.2500.230           
199522 9050.8410.7540.6800.6110.5540.5050.4620.4230.3870.3550.3260.3010.2770.254            
199624 9660.8320.7500.6740.6110.5560.5090.4580.4210.3850.3530.3240.2970.272             
199725 5750.8380.7520.6810.6200.5630.5140.4700.4270.3910.3580.3280.300              
199826 8760.8450.7660.6980.6370.5760.5260.4770.4350.4000.3680.337               
199927 8410.8510.7740.7060.6410.5820.5300.4840.4430.4040.366                
200029 3300.8560.7770.7110.6490.5910.5370.4910.4460.407                 
200130 9480.8550.7750.7070.6410.5870.5350.4870.445                  
200231 6860.8590.7810.7140.6510.5910.5370.489                   
200332 7560.8600.7830.7160.6540.5960.542                    
200433 9830.8670.7910.7240.6630.604                     
200535 0720.8630.7880.7200.658                      
200636 3250.8710.7950.728                       
200737 1570.8680.797                        
200837 9220.868                         
image

Figure 1. Changes in cumulative survival rate of patients started on dialysis for each year.

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The 1–10-year survival rates have been increasing since 1992 for patients who were started on dialysis in 1992 or later. This trend may be due to the improvement of anemia therapy using erythropoietin starting at the initial phase of dialysis because the clinical use of genetically modified erythropoietin started around this time.

Current status of dialysis fluid quality

Since 2006, the current status of bacteriological quality of dialysis fluid has been investigated in the facility survey. In the microbiological quality standard for dialysis fluids (3) established in 2008 by the Committee of Scientific Academy of JSDT, the unit of endotoxin concentration was changed from EU/L to EU/mL in accordance with ISO standards for dialysis related therapy. The survey at the end of 2008 also followed this standard, then the unit of endotoxin concentration was changed from EU/L to EU/mL. In the 2008 survey, however, many wrong values possibly resulting from misunderstanding of the unit of endotoxin concentration were found. Therefore, the tabulated results on endotoxin concentration in the dialysis fluid were not included in the 2008 report (4). In the 2009 report, however, the tabulated results on endotoxin concentration in the dialysis fluid were provided because the change in the unit of endotoxin concentration was expected to be widely known already.

Frequency of measurement of endotoxin concentration in dialysis fluid (Table 16)
Table 16. Frequencies of measurement of endotoxin concentration in dialysis fluid in different medical organizations (number of bedside consoles ≥1)
Kind of facilityNoneEvery dayEvery weekEvery 2 weeksEvery monthSeveral times per yearOnce a yearSubtotalUnspecifiedNo information availableTotal
  1. Kouseiren: an association for welfare belonging to agricultural cooperative associations.

National public university hospital310123193502052
(%)(6.0)(2.0)(0.0)(2.0)(46.0)(38.0)(6.0)(100.0)   
Private university hospital302823223611062
(%)(4.9)(0.0)(3.3)(13.1)(37.7)(36.1)(4.9)(100.0)   
National hospital100109142363039
(%)(27.8)(0.0)(2.8)(0.0)(25.0)(38.9)(5.6)(100.0)   
Prefectural Municipal Village hospital4213129718063398218427
(%)(10.6)(0.3)(0.8)(3.0)(24.4)(45.2)(15.8)(100.0)   
Social insurance hospital600217326630063
(%)(9.5)(0.0)(0.0)(3.2)(27.0)(50.8)(9.5)(100.0)   
“Kouseiren” hospital801543381711271120
(%)(7.1)(0.0)(0.9)(4.5)(38.4)(33.9)(15.2)(100.0)   
Other public hospital1616361681817361180
(%)(9.2)(0.6)(3.5)(1.7)(35.3)(39.3)(10.4)(100.0)   
Private general hospital1312729401210451110
(%)(12.5)(1.0)(1.9)(6.7)(27.9)(38.5)(11.5)(100.0)   
Private hospital1286185328939016210466171114
(%)(12.2)(0.6)(1.7)(5.1)(27.6)(37.3)(15.5)(100.0)   
Private clinic1811151138448666271176687301883
(%)(10.2)(0.6)(2.9)(7.8)(25.4)(37.7)(15.3)(100.0)   
Total4102184229103914695573809193484050
(%)(10.8)(0.6)(2.2)(6.0)(27.3)(38.6)(14.6)(100.0)   

There were 3809 facilities that responded to questions regarding the frequency of measurement of endotoxin concentration in the dialysis fluid. Table 16 shows a summary of the frequencies of measurement of endotoxin concentration in the dialysis fluid in different medical organizations. The measurement of endotoxin concentration in the dialysis fluid in all types of medical organization was moderately more frequent than in the previous year (4). Namely, in 2009, the endotoxin concentration in the dialysis fluid was measured at least once a year in 89.2% of the facilities that responded to the questionnaire, an increase of 1.7 points from the previous year (87.5%). Moreover, the percentage of facilities that carried out the measurement at least once a month, as recommended in the JSDT standard (3), was 36.0%, an increase of 2.9 points from 2008 (33.1%). However, these results are still unsatisfactory and the importance of frequent measurement of endotoxin in dialysis fluid should be continuously educated.

Endotoxin concentration in dialysis fluid (Table 17)
Table 17. Endotoxin concentration in dialysis fluid (EU/mL) in different medical organizations (number of bedside consoles ≥1)
Kind of facilityEndotoxin concentration (EU/mL) in dialysis fluidSubtotalUnspecifiedNo information availableTotal
Less than 0.0010.001∼0.01∼0.05∼0.1∼0.25∼0.5∼
  1. Kouseiren: an association for welfare belonging to agricultural cooperative associations.

National Public university hospital241063201462452
(%)(52.2)(21.7)(13.0)(6.5)(4.3)(0.0)(2.2)(100.0)   
Private university hospital331154211572362
(%)(57.9)(19.3)(8.8)(7.0)(3.5)(1.8)(1.8)(100.0)   
National hospital146302112721039
(%)(51.9)(22.2)(11.1)(0.0)(7.4)(3.7)(3.7)(100.0)   
Prefectural Municipal Village hospital218562918121063492652427
(%)(62.5)(16.0)(8.3)(5.2)(3.4)(2.9)(1.7)(100.0)   
Social insurance hospital311252312560763
(%)(55.4)(21.4)(8.9)(3.6)(5.4)(1.8)(3.6)(100.0)   
“Kouseiren” hospital562077234991110120
(%)(56.6)(20.2)(7.1)(7.1)(2.0)(3.0)(4.0)(100.0)   
Other public hospital902312109331501218180
(%)(60.0)(15.3)(8.0)(6.7)(6.0)(2.0)(2.0)(100.0)   
Private general hospital431410766490515110
(%)(47.8)(15.6)(11.1)(7.8)(6.7)(6.7)(4.4)(100.0)   
Private hospital4731798661422433898781381114
(%)(52.7)(19.9)(9.6)(6.8)(4.7)(2.7)(3.7)(100.0)   
Private clinic8832761638268315015531152151883
(%)(56.9)(17.8)(10.5)(5.3)(4.4)(2.0)(3.2)(100.0)   
Total18656073261941488010533252534724050
(%)(56.1)(18.3)(9.8)(5.8)(4.5)(2.4)(3.2)(100.0)   

Table 17 shows a summary of endotoxin concentrations in the dialysis fluid used in different medical organizations. The JSDT standard for endotoxin concentration for standard dialysis fluid is less than 0.05 EU/mL, and the percentage of facilities that satisfied this standard was 84.2% (vs. 89.1% in the 2006 survey and 93.6% in the 2007 survey). Moreover, the percentage of facilities that reported an endotoxin concentration of 0.5 EU/mL or more was 3.2% (vs. 1.0% in the 2006 survey and 0.4% in the 2007 survey), suggesting that some facilities might have used the wrong unit of measurement of endotoxin concentration (3,5,6).

Frequency of measurement of bacterial count in dialysis fluid (Table 18)
Table 18. Frequencies of measurement of bacterial count in dialysis fluid in different medical organizations (number of bedside consoles ≥1)
Kind of facilityMeasurement frequency of bacterial count in the dialysis fluidSubtotalUnspecifiedNo information availableTotal
NoneEvery dayEvery weekEvery two weeksEvery monthSeveral times per yearOnce a year
  1. Kouseiren: an association for welfare belonging to agricultural cooperative associations.

National public university hospital1200016162466052
(%)(26.1)(0.0)(0.0)(0.0)(34.8)(34.8)(4.3)(100.0)   
Private university hospital1301416206602062
(%)(21.7)(0.0)(1.7)(6.7)(26.7)(33.3)(10.0)(100.0)   
National hospital22021272363039
(%)(61.1)(0.0)(5.6)(2.8)(5.6)(19.4)(5.6)(100.0)   
Prefectural Municipal Village hospital164018629646377428427
(%)(43.5)(0.0)(0.3)(2.1)(16.4)(25.5)(12.2)(100.0)   
Social insurance hospital1401012198549063
(%)(25.9)(0.0)(1.9)(0.0)(22.2)(35.2)(14.8)(100.0)   
“Kouseiren” hospital37003372111109101120
(%)(33.9)(0.0)(0.0)(2.8)(33.9)(19.3)(10.1)(100.0)   
Other public hospital61027424113166131180
(%)(36.7)(0.0)(1.2)(4.2)(25.3)(24.7)(7.8)(100.0)   
Private general hospital4602618161210082110
(%)(46.0)(0.0)(2.0)(6.0)(18.0)(16.0)(12.0)(100.0)   
Private hospital38111038216236117999104111114
(%)(38.1)(0.1)(1.0)(3.8)(21.6)(23.6)(11.7)(100.0)   
Private clinic6757211082903891901680170331883
(%)(40.2)(0.4)(1.3)(6.4)(17.3)(23.2)(11.3)(100.0)   
Total14258401757118614073627367564050
(%)(39.3)(0.2)(1.1)(4.8)(19.6)(23.7)(11.2)(100.0)   

There were 3627 facilities that responded to questions regarding the frequency of measurement of the bacterial count in the dialysis fluid. The number of facilities that measured bacterial count has been increasing since the start of the annual survey. A bacterial count was measured at 60.7% of the 3627 facilities, 6.2 points increase from the end of 2008 (54.5%) (4). The percentage of facilities that measured bacterial count was only 37.1% at the end of 2006, an increase of 23.6 points over the past 3 years (5).

The JSDT standard (3) recommends that the bacterial count measurement should be monitored at least once a month. The percentage of facilities that satisfied the standard was 25.8% in 2009, an increase of 5.0 points from 2008 (20.8%) (4). Thus, while the measurement of the bacterial count in the dialysis fluid has become more common, the percentage of facilities that met the standard was still unsatisfactory, indicating that the importance of frequent measurement of bacterial count should be continuously educated.

Bacterial count in dialysis fluid (Table 19)
Table 19. Number of facilities for different bacterial counts in dialysis fluid (cfu/mL) and cultivation media (number of bedside consoles ≥1) dialysis fluid
Media used for bacterial cultivation of dialysis fluidBacterial count in dialysis fluid (cfu/mL)SubtotalUnspecifiedNo information availableTotal
Less than 0.10.1∼1∼10∼100∼
  1. 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.

General agar medium1493531142231150246
(%)(64.5)(15.2)(13.4)(6.1)(0.9)(100.0)   
R2A medium6252582391232512705131324
(%)(49.2)(20.3)(18.8)(9.7)(2.0)(100.0)   
TGEA medium18457338328561292
(%)(64.6)(20.0)(11.6)(2.8)(1.1)(100.0)   
Blood agar medium264120334037
(%)(78.8)(12.1)(3.0)(6.1)(0.0)(100.0)   
TSA medium72100102012
(%)(70.0)(20.0)(10.0)(0.0)(0.0)(100.0)   
Other media77192392130182150
(%)(59.2)(14.6)(17.7)(6.9)(1.5)(100.0)   
Subtotal10683753281563219599662061
(%)(54.5)(19.1)(16.7)(8.0)(1.6)(100.0)   
Unspecified541617961023979491448
(%)(52.9)(15.7)(16.7)(8.8)(5.9)(100.0)   
No information available1000011539541
(%)(100.0)(0.0)(0.0)(0.0)(0.0)(100.0)   
Total112339134516538206249414944050
(%)(54.5)(19.0)(16.7)(8.0)(1.8)(100.0)   

Bacterial counts in the dialysis fluid were reported by 2062 facilities, 98.2% of which satisfied the JSDT standard (3), that is, less than 100 cfu/mL. The percentage of facilities that satisfied a bacterial count of less than 0.1 cfu/mL, which ensures the entity of ultrapure dialysis fluid, was 54.5%. These percentages were greater than those in 2008 (97.6% for less than 100 cfu/mL and 50.7% for less than 0.1 cfu/mL) (4).

Cultivation media used for bacterial count in dialysis fluid (Table 19)

According to the JSDT standard, Reasoner's no. 2 agar (R2A) and tryptone glucose extract agar (TGEA) or equivalent media are recommended for the cultivation of bacteria in the dialysis fluid (3). The survey results showed that these media were used at 78.4% of the facilities. The results of the 2007 survey showed that 73.4% of the facilities used R2A or TGEA, indicating that the percentage of facilities that used a medium recommended in the standard increased by 5.0 points over the past 2 years.

Sampling volume for measurement of bacterial count in dialysis fluid (Table 20)
Table 20. Number of facilities for different bacterial counts in dialysis fluid (cfu/mL) and volumes of samples for measurement of bacterial count (number of bedside consoles ≥1)
Amount of sampleBacterial count in dialysis fluid (cfu/mL)SubtotalUnspecifiedNo information availableTotal
Less than 0.10.1∼1∼10∼100∼
  1. The values in parentheses under each figure represent the percentage relative to the total in each row.

less than 1 mL147262370203220225
(%)(72.4)(12.8)(11.3)(3.4)(0.0)(100.0)   
1 mL∼3261251255711644511696
(%)(50.6)(19.4)(19.4)(8.9)(1.7)(100.0)   
10 mL∼2571211035112544235572
(%)(47.2)(22.2)(18.9)(9.4)(2.2)(100.0)   
50 mL∼24788593011435121448
(%)(56.8)(20.2)(13.6)(6.9)(2.5)(100.0)   
100 mL∼9324238215030153
(%)(62.0)(16.0)(15.3)(5.3)(1.3)(100.0)   
500 mL∼133470272029
(%)(48.1)(11.1)(14.8)(25.9)(0.0)(100.0)   
1 L∼141110173020
(%)(82.4)(5.9)(5.9)(5.9)(0.0)(100.0)   
10 L∼500016107
(%)(83.3)(0.0)(0.0)(0.0)(16.7)(100.0)   
Subtotal110238833816137202611772150
(%)(54.4)(19.2)(16.7)(7.9)(1.8)(100.0)   
Unspecified213741363779491362
(%)(58.3)(8.3)(19.4)(11.1)(2.8)(100.0)   
No information available0000000538538
(%)(0.0)(0.0)0.0)(0.0)(0.0)(0.0)   
Total112339134516538206249414944050
(%)(54.5)(19.0)(16.7)(8.0)(1.8)(100.0)   

Generally, the sampling volume of dialysis fluid for measuring bacterial count in plate media is less than 1 mL. However, at least 10 mL of a dialysis fluid sample is required to measure a bacterial count of less than 0.1 cfu/mL, which ensures the entity of ultrapure dialysate fluid (3). The percentage that sampled more than 10 mL for bacterial count was 57.2% of the facilities that responded to the questions regarding the volume of the sample. The percentages of facilities that sampled at least 10 mL of dialysis fluid were 46.5% in 2007 and 52.0% in 2008, increasing yearly (5,6).

Installation of ETRFs (Table 21)
Table 21. Percentages of facilities that have bedside consoles with endotoxin retentive filter (ETRF) in different medical organizations (number of bedside consoles ≥1)
Percentages of facilities that have bedside consoles with ETRF (%)SubtotalMeanSD
Kind of facility0% (No ETRF)<10%10∼20∼30∼40∼50∼60∼70∼80∼90∼100% (All consoles equipped with ETRF)
  1. Kouseiren: an association for welfare belonging to agricultural cooperative associations.

National public university hospital30010000103445291.7725.53
(%)(5.8)(0.0)(0.0)(1.9)(0.0)(0.0)(0.0)(0.0)(1.9)(0.0)(5.8)(84.6)(100.0)  
Private university hospital31102222013456285.2630.01
(%)(4.8)(1.6)(1.6)(0.0)(3.2)(3.2)(3.2)(3.2)(0.0)(1.6)(4.8)(72.6)(100.0)  
National hospital10000012121313992.5419.20
(%)(2.6)(0.0)(0.0)(0.0)(0.0)(0.0)(2.6)(5.1)(2.6)(5.1)(2.6)(79.5)(100.0)  
Prefectural Municipal Village hospital3621139861088112627142777.6436.84
(%)(8.4)(4.9)(3.0)(2.1)(1.9)(1.4)(2.3)(1.9)(1.9)(2.6)(6.1)(63.5)(100.0)  
Social insurance hospital52224121156326374.5536.38
(%)(7.9)(3.2)(3.2)(3.2)(6.3)(1.6)(3.2)(1.6)(1.6)(7.9)(9.5)(50.8)(100.0)  
“Kouseiren” hospital454592314177512078.4234.18
(%)(3.3)(4.2)(3.3)(4.2)(7.5)(1.7)(2.5)(0.8)(3.3)(0.8)(5.8)(62.5)(100.0)  
Other public hospital13584227578511418078.7734.71
(%)(7.2)(2.8)(4.4)(2.2)(1.1)(1.1)(3.9)(2.8)(3.9)(4.4)(2.8)(63.3)(100.0)  
Private general hospital1366213102176811073.5240.49
(%)(11.8)(5.5)(5.5)(1.8)(0.9)(2.7)(0.9)(0.0)(1.8)(0.9)(6.4)(61.8)(100.0)  
Private hospital13652503535282920193164615111470.6240.06
(%)(12.2)(4.7)(4.5)(3.1)(3.1)(2.5)(2.6)(1.8)(1.7)(2.8)(5.7)(55.2)(100.0)  
Private clinic315122936552514047324976941188364.0942.67
(%)(16.7)(6.5)(4.9)(3.5)(2.8)(2.7)(2.1)(2.5)(1.7)(2.6)(4.0)(50.0)(100.0)  
Total529214177123113959586751091982236405069.7640.63
(%)(13.1)(5.3)(4.4)(3.0)(2.8)(2.3)(2.3)(2.1)(1.9)(2.7)(4.9)(55.2)(100.0)  

There were 4050 facilities that responded to the questions regarding the installation of ETRFs. The percentage of facilities that installed ETRF was 86.9%, an increase of 2.9 points from 2008 (84.0%) (4).

Regarding the number of bedside consoles, 78 014 bedside consoles (68.4%) were equipped with an ETRF among 114 086 bedside consoles in the facilities that responded to the question about the number of ETRFs installed.

Current status of PD therapy

In the 2009 survey, non-member facilities that treated only PD patients were included in the survey although they were not included in the previous surveys. In this section, the tabulated results on the survey items related to PD are summarized.

Here, patients who underwent both PD and other blood purification therapies using extracorporeal circulation such as HD and HDF are referred to as “PD + other therapy patients.” Patients who underwent only blood purification therapy using extracorporeal circulation such as HD and HDF are referred to as “non-PD patients.” Patients who underwent blood purification therapy using extracorporeal circulation such as HD and HDF alone and have a catheter for PD inserted are referred to as “non-PD + catheter patients.”

Current status of combined use of PD and other therapies in different medical organizations (Tables 22,23)
Table 22. Number of patients who underwent peritoneal dialysis (PD) and other therapies determined by results of facility survey
 Patients who responded in facility survey that they underwent daytime dialysis, nighttime dialysis, or home HD 
Method of therapyPD (according to results of facility survey)Non-PD + catheter patientsPatients who were started on PD in 2009 but introduced to other therapies in the same yearTotal
Number of patients985843719610 491
Among the above, 1720 patients underwent both PD and others.   
Table 23. Current status of combined use of peritoneal dialysis (PD) and other therapies in different medical organizations (for all dialysis patients)
Kind of facilityCurrent status of combined use of PD and other therapiesSubtotalUnspecifiedNo information availableTotal
Non-PDPD onlyNon-PD + catheterPD + other therapies (once a week)PD + other therapies (twice a week)PD + other therapies (three times a week)PD + other therapies (other frequency)
  1. Kouseiren: an association for welfare belonging to agricultural cooperative associations.

National Public university hospital3453571346107440230974
(%)(46.4)(48.0)(0.1)(4.6)(0.8)(0.1)(0.0)(100.0)   
Private university hospital1 55179581167142 48204662 948
(%)(62.5)(32.0)(0.3)(4.7)(0.3)(0.0)(0.2)(100.0)   
National hospital320850131004190235654
(%)(76.4)(20.3)(0.0)(3.1)(0.2)(0.0)(0.0)(100.0)   
Prefectural Municipal Village hospital13 7061110331723152515 08204 13119 213
(%)(90.9)(7.4)(0.2)(1.1)(0.2)(0.0)(0.2)(100.0)   
Social insurance hospital2 5362097493102 80506133 418
(%)(90.4)(7.5)(0.2)(1.7)(0.1)(0.0)(0.0)(100.0)   
“Kouseiren” hospital6 0764187909346 60712 3438 951
(%)(92.0)(6.3)(0.1)(1.4)(0.1)(0.0)(0.1)(100.0)   
Other public hospital7 50781723138139188 52501 76410 289
(%)(88.1)(9.6)(0.3)(1.6)(0.2)(0.1)(0.2)(100.0)   
Private general hospital5 26630665834815 67901 4697 148
(%)(92.7)(5.4)(0.1)(1.0)(0.6)(0.1)(0.0)(100.0)   
Private hospital66 43513114823926104368 112214 21282 326
(%)(97.5)(1.9)(0.1)(0.4)(0.0)(0.0)(0.1)(100.0)   
Private clinic113 04361477288611533114 131031 944146 075
(%)(99.0)(0.5)(0.1)(0.3)(0.1)(0.0)(0.0)(100.0)   
Total216 7856022210119719153128224 586357 407281 996
(%)(96.5)(2.7)(0.1)(0.5)(0.1)(0.0)(0.1)(100.0)   

According to the facility survey, the number of PD patients was 9858 at the end of 2009, an increase of 558 patients from the 2008 survey (9300 patients). Moreover, the number of non-PD + catheter patients was 437 and that of new patients who were started on PD in 2009 but introduced to other therapies in the same year was 196. The total number of these patients was 633. These 633 patients were not classified as PD patients in the previous surveys. The sum of these 633 patients and the abovementioned PD patients (i.e. the total number of PD-therapy-related patients) was 10 491 (Table 22).

The details of the combined use of PD and other therapies were investigated in the patient survey. According to the results, the number of PD + other therapy patients was 1569 (Table 23). It was considered that, in the abovementioned facility survey, most of these PD + other therapy patients were counted as PD patients but some were probably counted as patients who underwent HD or other therapies. According to the results of the patient survey at the end of 2009, the number of patients who responded that they underwent only PD (referred to as “PD-only patients”) was 6022. Therefore, the sum of this and the number of PD + other therapy patients (1569) (i.e. the total number of patients who underwent PD alone or with other therapies) was 7591. Among these 7591 PD-treated patients, 1197 patients (15.8%) underwent HD or other therapies once a week, 191 patients (2.5%) did so twice a week, and 53 patients (0.7%) did so three times a week. The PD + other therapy patients (1569) accounted for 20.7% of the PD-treated patients (7591).

Table 23 shows the current status of the combined use of PD and other therapies in different medical organizations. To easily understand the differences in the distribution of patients who underwent different therapies among medical organizations, national, public, and private universities were classified as university hospitals. National organizations, prefectural and municipal organizations, social insurance organizations, welfare federation of agricultural cooperatives, and other public organizations were classified as public hospitals. Private general hospitals and private hospitals were classified as private hospitals. Private clinics were simply classified as private clinics. The data shown in Table 23 are analyzed following the new classification as follows. According to the analytical results, most of the non-PD patients were treated in private hospitals and clinics and few were treated in university and public hospitals (university hospitals, 0.9%; public hospitals, 13.9%; private hospitals, 33.1%; private clinics, 52.1%). In contrast, many of the PD-only patients were treated in university and public hospitals and few were treated in private clinics (university hospitals, 19.1%; public hospitals, 43.8%; private hospitals, 26.9%; private clinics, 10.2%). The number of PD + other therapy patients showed an intermediate distribution of the above two groups of patients (university hospitals, 10.8%; public hospitals, 37.2%; private hospitals, 26.7%; private clinics, 25.3%). The distribution of the number of non-PD + catheter patients was closer to the number of non-PD patients than the number of PD + other therapy patients.

The above findings indicate a tendency that, in Japan, PD patients are mainly treated in university and public hospitals, whereas non-PD patients are mainly treated in private medical organizations.

Combined use of PD and other therapies for various age groups (Table 24)
Table 24. Current status of combined use of peritoneal dialysis (PD) and other therapies for different age groups (for all dialysis patients)
Age (years)Current status of combined use of PD and other therapiesSubtotalUnspecifiedNo information availableTotal
Non-PDPD onlyNon-PD + catheterPD + other therapies (once a week)PD + other therapies (twice a week)PD + other therapies (three times a week)PD + other therapies (other frequency)
<156540000060048108
(%)(10.0)(90.0)(0.0)(0.0)(0.0)(0.0)(0.0)(100.0)   
15–291 026964215011 15303001 453
(%)(89.0)(8.3)(0.3)(1.8)(0.4)(0.0)(0.1)(100.0)   
30–4412 044540281732471512 83103 33116 162
(%)(93.9)(4.2)(0.2)(1.3)(0.2)(0.1)(0.1)(100.0)   
45–5947 12617895048567155749 589112 49962 089
(%)(95.0)(3.6)(0.1)(1.0)(0.1)(0.0)(0.1)(100.0)   
60–7499 035251798430822039102 221125 865128 087
(%)(96.9)(2.5)(0.1)(0.4)(0.1)(0.0)(0.0)(100.0)   
75–8954 970978298513101656 101114 67770 779
(%)(98.0)(1.7)(0.1)(0.2)(0.0)(0.0)(0.0)(100.0)   
90–2 57648130102 62906723 301
(%)(98.0)(1.8)(0.0)(0.1)(0.0)(0.0)(0.0)(100.0)   
Total216 7836022210119719153128224 584357 392281 979
(%)(96.5)(2.7)(0.1)(0.5)(0.1)(0.0)(0.1)(100.0)   
No information available2000000201517
(%)(100.0)(0.0)(0.0)(0.0)(0.0)(0.0)(0.0)(100.0)   
Total216 7856022210119719153128224 586357 407281 996
(%)(96.5)(2.7)(0.1)(0.5)(0.1)(0.0)(0.1)(100.0)   
Mean65.9461.2260.5556.8657.4162.6658.0365.7567.6765.8265.76
SD12.5014.3513.7012.3112.7013.2211.9612.6012.5012.7612.63

The relationship of the current status of combined use of PD and other therapies with age was analyzed (Table 24). The percentage of PD-treated patients (consisting of PD-only patients and PD + other therapy patients) among all dialysis patients was 90.0% for patients younger than 15 years. The percentage decreased with increasing age (15–29 years old, 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-PD patients was 65.9 years, whereas that of PD-only patients was younger at 61.2 years.

Combined use of PD and other therapies for different dialysis periods (Table 25)
Table 25. Current status of combined use of PD and other therapies for different dialysis periods (for all target patients)
Dialysis period (years)Current status of combined use of PD and other therapiesSubtotalUnspecifiedNo information availableTotal
Non-PDPD onlyNon-PD + catheterPD + other therapies (once a week)PD + other therapies (twice a week)PD + other therapies (three times a week)PD + other therapies (other frequency)
<247 7112681471552492650 653013 80864 461
(%)(94.2)(5.3)(0.1)(0.3)(0.0)(0.0)(0.1)(100.0)   
2–455 15120763941065142657 781214 69072 473
(%)(95.4)(3.6)(0.1)(0.7)(0.1)(0.0)(0.0)(100.0)   
5–955 4319905644860193357 037114 21371 251
(%)(97.2)(1.7)(0.1)(0.8)(0.1)(0.0)(0.1)(100.0)   
10–1427 710177421243452428 11606 95835 074
(%)(98.6)(0.6)(0.1)(0.4)(0.1)(0.0)(0.1)(100.0)   
15–1914 32751224054814 45703 65418 111
(%)(99.1)(0.4)(0.2)(0.3)(0.0)(0.0)(0.1)(100.0)   
20–247 838211120247 87801 9989 876
(%)(99.5)(0.3)(0.0)(0.2)(0.0)(0.0)(0.1)(100.0)   
25–8 61726383078 66402 08610 750
(%)(99.5)(0.3)(0.0)(0.1)(0.0)(0.0)(0.1)(100.0)   
Total216 7856022210119719153128224 586357 407281 996
(%)(96.5)(2.7)(0.1)(0.5)(0.1)(0.0)(0.1)(100.0)   
Mean7.122.876.895.755.916.497.947.003.336.826.97
SD7.213.676.014.644.975.777.437.151.537.097.14

The relationship between the current status of combined use of PD with other therapies and dialysis period was analyzed (Table 25). The percentage of PD-treated patients, consisting of PD-only patients and PD + other therapy patients, was 5.7% for patients on dialysis for less than 2 years and decreased 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 other therapies were observed even among patients on dialysis for less than 2 years.

The percentage of PD + other therapy patients among PD-treated patients (consisting of PD-only patients and PD + other therapy patients) was as high as 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 for different PD periods (Table 26)
Table 26. Current status of combined use of peritoneal dialysis (PD) and other therapies for different PD periods (for PD-treated patients)
PD period (years)Current status of combined use of PD and other therapiesSubtotalUnspecifiedNo information availableTotal
Non-PDPD onlyNon-PD + catheterPD + other therapies (once a week)PD + other therapies (twice a week)PD + other therapies (three times a week)PD + other therapies (other frequency)
<1010930589461170001170
(%)(0.0)(93.4)(0.0)(5.0)(0.8)(0.3)(0.5)(100.0)   
1–2015510195288191801001801
(%)(0.0)(86.1)(0.0)(10.8)(1.6)(0.4)(1.1)(100.0)   
3–40864021637681131001131
(%)(0.0)(76.4)(0.0)(19.1)(3.3)(0.5)(0.7)(100.0)   
5–6042901763051165100651
(%)(0.0)(65.9)(0.0)(27.0)(4.6)(0.8)(1.7)(100.0)   
7–902480161195844100441
(%)(0.0)(56.2)(0.0)(36.5)(4.3)(1.1)(1.8)(100.0)   
10–1401010812422022800228
(%)(0.0)(44.3)(0.0)(35.5)(10.5)(0.9)(8.8)(100.0)   
15–036028511710071
(%)(0.0)(50.7)(0.0)(39.4)(7.0)(1.4)(1.4)(100.0)   
Total04322091515231735493005493
(%)(0.0)(78.7)(0.0)(16.7)(2.8)(0.6)(1.3)(100.0)   
No information available0170002823922552098002098
(%)(0.0)(81.0)(0.0)(13.4)(1.9)(1.0)(2.6)(100.0)   
Total0602201197191531287591007591
(%)(0.0)(79.3)(0.0)(15.8)(2.5)(0.7)(1.7)(100.0)   
Mean 2.60 5.175.614.615.883.17  3.17
SD 2.94 3.914.244.284.563.38  3.38

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

Combined use of PD and other therapies for different primary diseases (Table 27)
Table 27. Current status of combined use of peritoneal dialysis (PD) and other therapies for different primary diseases (for all dialysis patients)
Primary diseaseCurrent status of combined use of PD and other therapiesSubtotalUnspecifiedNo information availableTotal
Non-PDPD onlyNon-PD + catheterPD + other therapies (once a week)PD + other therapies (twice a week)PD + other therapies (three times a week)PD + other therapies (other frequency)
Chronic glomerulonephritis81 153238810561191216984 438021 564106 002
(%)(96.1)(2.8)(0.1)(0.7)(0.1)(0.0)(0.1)(100.0)   
Chronic pyelonephritis2 341834180102 44706223 069
(%)(95.7)(3.4)(0.2)(0.7)(0.0)(0.0)(0.0)(100.0)   
Rapidly progressive glomerulonephritis1 50640192011 55904021 961
(%)(96.6)(2.6)(0.1)(0.6)(0.1)(0.0)(0.1)(100.0)   
Nephropathy of pregnancy/pregnancy toxemia1 33920243011 36903861 755
(%)(97.8)(1.5)(0.1)(0.3)(0.2)(0.0)(0.1)(100.0)   
Other nephritides that cannot be classified97941172011 03102841 315
(%)(95.0)(4.0)(0.1)(0.7)(0.2)(0.0)(0.1)(100.0)   
Polycystic kidney7 4091262246037 57001 9129 482
(%)(97.9)(1.7)(0.0)(0.3)(0.1)(0.0)(0.0)(100.0)   
Nephrosclerosis15 563601146665316 25803 87620 134
(%)(95.7)(3.7)(0.1)(0.4)(0.0)(0.0)(0.0)(100.0)   
Malignant hypertension1 656590111011 72804502 178
(%)(95.8)(3.4)(0.0)(0.6)(0.1)(0.0)(0.1)(100.0)   
Diabetic nephropathy76 78317146028258203278 949120 09099 040
(%)(97.3)(2.2)(0.1)(0.4)(0.1)(0.0)(0.0)(100.0)   
SLE nephritis1 79044170121 84504952 340
(%)(97.0)(2.4)(0.1)(0.4)(0.0)(0.1)(0.1)(100.0)   
Amyloidal kidney38011010013930123516
(%)(96.7)(2.8)(0.0)(0.3)(0.0)(0.0)(0.3)(100.0)   
Gouty kidney961230801099302581 251
(%)(96.8)(2.3)(0.0)(0.8)(0.0)(0.1)(0.0)(100.0)   
Renal failure due to congenital abnormality of metabolism1921011000204059263
(%)(94.1)(4.9)(0.5)(0.5)(0.0)(0.0)(0.0)(100.0)   
Kidney and urinary tract tuberculosis255301000259071330
(%)(98.5)(1.2)(0.0)(0.4)(0.0)(0.0)(0.0)(100.0)   
Kidney and urinary tract stone4479020004580110568
(%)(97.6)(2.0)(0.0)(0.4)(0.0)(0.0)(0.0)(100.0)   
Kidney and urinary tract tumor55815000005730155728
(%)(97.4)(2.6)(0.0)(0.0)(0.0)(0.0)(0.0)(100.0)   
Obstructive urinary tract disease53419011005550137692
(%)(96.2)(3.4)(0.0)(0.2)(0.2)(0.0)(0.0)(100.0)   
Myeloma169200000171036207
(%)(98.8)(1.2)(0.0)(0.0)(0.0)(0.0)(0.0)(100.0)   
Hypoplastic kidney42246030004710114585
(%)(89.6)(9.8)(0.0)(0.6)(0.0)(0.0)(0.0)(100.0)   
Undetermined16 40260717106173917 16124 66321 826
(%)(95.6)(3.5)(0.1)(0.6)(0.1)(0.0)(0.1)(100.0)   
Reintroduction after transplantation1 621392121031 67803702 048
(%)(96.6)(2.3)(0.1)(0.7)(0.1)(0.0)(0.2)(100.0)   
Others4 2881200233124 43701 1865 623
(%)(96.6)(2.7)(0.0)(0.5)(0.1)(0.0)(0.0)(100.0)   
Total216 7486020210119719153128224 547357 363281 913
(%)(96.5)(2.7)(0.1)(0.5)(0.1)(0.0)(0.1)(100.0)   
No information available372000003904483
(%)(94.9)(5.1)(0.0)(0.0)(0.0)(0.0)(0.0)(100.0)   
Total216 7856022210119719153128224 586357 407281 996
(%)(96.5)(2.7)(0.1)(0.5)(0.1)(0.0)(0.1)(100.0)   

The relationship between the current status of combined use of PD and other therapies and primary diseases was analyzed (Table 27). The percentages of patients with diabetic nephropathy as the primary disease were 35.4% for non-PD patients, 28.5% for PD-only patients, and 25.0% for PD + other therapy patients.

Items associated with CKD-MBD

In 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)
Table 28. Predialysis corrected serum calcium levels (mg/dL) for different dialysis methods (for all dialysis patients)
Predialysis corrected serum calcium levels (mg/dL)SubtotalNo information availableTotalMeanSD
Dialysis method<6.06.0∼7.1∼8.4∼9.3∼10.1∼11.1∼12.0∼
  1. 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.

Facility HD18375219 67292 12874 43428 00535941305220 07333 734253 8079.290.88
(%)(0.1)(0.3)(8.9)(41.9)(33.8)(12.7)(1.6)(0.6)(100.0)    
HDF10381 0045 2855 5692 51136511714 8991 95416 8539.450.97
(%)(0.1)(0.3)(6.7)(35.5)(37.4)(16.9)(2.4)(0.8)(100.0)    
HF00103040150196641609.370.77
(%)(0.0)(0.0)(10.4)(31.3)(41.7)(15.6)(0.0)(1.0)(100.0)    
Hemoadsorption37925446053264171 6251631 7889.470.83
(%)(0.2)(0.4)(5.7)(33.5)(37.2)(20.1)(2.5)(0.4)(100.0)    
Home HD02959581611146782249.270.83
(%)(0.0)(1.4)(6.2)(40.4)(39.7)(11.0)(0.7)(0.7)(100.0)    
PD6273351 8072 4601 122157515 9653 1999 1649.520.90
(%)(0.1)(0.5)(5.6)(30.3)(41.2)(18.8)(2.6)(0.9)(100.0)    
Total20282621 12299 85383 16631 99541581482242 80439 192281 9969.310.89
(%)(0.1)(0.3)(8.7)(41.1)(34.3)(13.2)(1.7)(0.6)(100.0)    
Table 29. Predialysis serum phosphorus levels (mg/dL) for different dialysis methods (for all dialysis patients)
Dialysis methodPredialysis serum phosphorus levels (mg/dL)SubtotalNo information availableTotalMeanSD
<2.02.0∼3.5∼4.8∼6.1∼7.0∼8.0∼9.0∼
  1. 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.

Facility HD135525 26276 70172 09828 70613 9005 1273118226 26727 540253 8075.041.48
(%)(0.6)(11.2)(33.9)(31.9)(12.7)(6.1)(2.3)(1.4)(100.0)    
HDF771 3054 6275 2862 1671 06039222415 1381 71516 8535.211.47
(%)(0.5)(8.6)(30.6)(34.9)(14.3)(7.0)(2.6)(1.5)(100.0)    
HF21922351043196641604.841.49
(%)(2.1)(19.8)(22.9)(36.5)(10.4)(4.2)(3.1)(1.0)(100.0)    
Hemoadsorption21174966762439218141 6581301 7885.181.25
(%)(0.1)(7.1)(29.9)(40.8)(14.7)(5.5)(1.1)(0.8)(100.0)    
Home HD012615912202148762244.841.10
(%)(0.0)(8.1)(41.2)(39.9)(8.1)(1.4)(0.0)(1.4)(100.0)    
PD226621 9772 069817366139646 1163 0489 1645.081.40
(%)(0.4)(10.8)(32.3)(33.8)(13.4)(6.0)(2.3)(1.0)(100.0)    
Total145827 37783 88480 22331 95515 4245 6793423249 42332 573281 9965.051.47
(%)(0.6)(11.0)(33.6)(32.2)(12.8)(6.2)(2.3)(1.4)(100.0)    
Table 30. Predialysis serum magnesium levels (mg/dL) for different dialysis methods (for all dialysis patients)
Dialysis methodPredialysis serum magnesium levels (mg/dL)SubtotalNo information availableTotalMeanSD
0.1∼0.9∼1.8∼2.7∼3.5∼4.4∼5.2∼6.1∼
  1. 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.

Facility HD36226387 07255 8004650621250233150 925102 882253 8072.600.53
(%)(0.0)(1.5)(57.7)(37.0)(3.1)(0.4)(0.2)(0.2)(100.0)    
HDF1965 7154 01427740131310 1696 68416 8532.620.48
(%)(0.0)(0.9)(56.2)(39.5)(2.7)(0.4)(0.1)(0.1)(100.0)    
HF0015122100301301602.620.62
(%)(0.0)(0.0)(50.0)(40.0)(6.7)(3.3)(0.0)(0.0)(100.0)    
Hemoadsorption018723419222121 1876011 7882.580.61
(%)(0.0)(1.5)(60.9)(35.3)(1.9)(0.2)(0.1)(0.2)(100.0)    
Home HD01952010011181062242.490.82
(%)(0.0)(0.8)(80.5)(16.9)(0.8)(0.0)(0.0)(0.8)(100.0)    
PD03452 00952777155102 9886 1769 1642.350.92
(%)(0.0)(11.5)(67.2)(17.6)(2.6)(0.5)(0.2)(0.3)(100.0)    
Total37272395 62960 7925029679269259165 417116 579281 9962.600.54
(%)(0.0)(1.6)(57.8)(36.8)(3.0)(0.4)(0.2)(0.2)(100.0)    
Table 31. Tests of serum parathyroid hormone (PTH) level for different dialysis methods (for all dialysis patients)
Dialysis methodTests of serum parathyroid hormone (PTH) levelUnspecifiedNo information availableTotal
intact-PTHwhole-PTHHS-PTHOtherSubtotal
  1. 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.

Facility HD186 73920 7117881003209 241244 564253 807
(%)(89.2)(9.9)(0.4)(0.5)(100.0)   
HDF12 8941 238323314 19702 65616 853
(%)(90.8)(8.7)(0.2)(0.2)(100.0)   
HF8830091069160
(%)(96.7)(3.3)(0.0)(0.0)(100.0)   
Hemoadsorption1 4151561131 58502031 788
(%)(89.3)(9.8)(0.7)(0.2)(100.0)   
Home HD1391000149075224
(%)(93.3)(6.7)(0.0)(0.0)(100.0)   
PD4 77565711635 50623 6569 164
(%)(86.7)(11.9)(0.2)(1.1)(100.0)   
Total206 05022 7758421102230 769451 223281 996
(%)(89.3)(9.9)(0.4)(0.5)(100.0)   
Table 32. Serum intact-parathyroid hormone (PTH) levels (pg/mL) for different dialysis methods (for all dialysis patients)
Dialysis methodSerum intact-parathyroid hormone (PTH) levels (pg/mL)SubtotalNo information availableTotalMeanSD
<3131∼61∼121∼181∼361∼721∼1441∼
  1. 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.

Facility HD19 40022 87645 27536 23643 68811 4891 809280181 0535686186 739162163
(%)(10.7)(12.6)(25.0)(20.0)(24.1)(6.3)(1.0)(0.2)(100.0)    
HDF1 3891 4272 8772 5053 1829451633312 52137312 894174186
(%)(11.1)(11.4)(23.0)(20.0)(25.4)(7.5)(1.3)(0.3)(100.0)    
HF25181161951186288161322
(%)(29.1)(20.9)(12.8)(7.0)(22.1)(5.8)(1.2)(1.2)(100.0)    
Hemoadsorption223145303237365902101 384311 415163157
(%)(16.1)(10.5)(21.9)(17.1)(26.4)(6.5)(1.5)(0.0)(100.0)    
Home HD111428303617301390139205184
(%)(7.9)(10.1)(20.1)(21.6)(25.9)(12.2)(2.2)(0.0)(100.0)    
PD2763869148161 351530110134 3963794 775217212
(%)(6.3)(8.8)(20.8)(18.6)(30.7)(12.1)(2.5)(0.3)(100.0)    
Total21 32424 86649 40839 83048 64113 0762 107327199 5796471206 050164166
(%)(10.7)(12.5)(24.8)(20.0)(24.4)(6.6)(1.1)(0.2)(100.0)    
Table 33. Serum whole-parathyroid hormone (PTH) levels (pq/mL) for different dialysis methods (for all dialysis patients)
Dialysis methodSerum whole-parathyroid hormone (PTH) levels (pq/mL)SubtotalNo information availableTotalMeanSD
<2121∼36∼71∼101∼211∼421∼851∼
  1. 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.

Facility HD2448237347843143541817063995920 33038120 711106115
(%)(12.0)(11.7)(23.5)(15.5)(26.7)(8.4)(2.0)(0.3)(100.0)    
HDF1891382911792981052711 228101 238102111
(%)(15.4)(11.2)(23.7)(14.6)(24.3)(8.6)(2.2)(0.1)(100.0)    
HF110010003035562
(%)(33.3)(33.3)(0.0)(0.0)(33.3)(0.0)(0.0)(0.0)(100.0)    
Hemoadsorption222031273513401524156106126
(%)(14.5)(13.2)(20.4)(17.8)(23.0)(8.6)(2.6)(0.0)(100.0)    
Home HD 21006009110201133
(%) (22.2)(11.1)(0.0)(0.0)(66.7)(0.0)(0.0)(100.0)    
PD7172139961606618562730657120147
(%)(11.3)(11.5)(22.2)(15.3)(25.5)(10.5)(2.9)(0.8)(100.0)    
Total2731260652463445591218964486522 34942622 775106116
(%)(12.2)(11.7)(23.5)(15.4)(26.5)(8.5)(2.0)(0.3)(100.0)    
Table 34. Predialysis serum alkaline phosphatase (ALP) levels (IU/L) for different dialysis methods (for all dialysis patients)
Dialysis methodPredialysis serum ALP levels (IU/L)SubtotalNo information availableTotalMeanSD
<7171∼111∼201∼281∼361∼501∼751∼1001∼1501∼
  1. 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.

Facility HD786302268 71173 67038 52723 09274481375553267217 45136 356253 807265146
(%)(0.4)(1.4)(31.6)(33.9)(17.7)(10.6)(3.4)(0.6)(0.3)(0.1)(100.0)    
HDF301734 3214 8652 6901 764632106482414 6532 20016 853277162
(%)(0.2)(1.2)(29.5)(33.2)(18.4)(12.0)(4.3)(0.7)(0.3)(0.2)(100.0)    
HF 3283316911 39466160304311
(%) (3.2)(29.8)(35.1)(17.0)(9.6)(1.1)(1.1) (3.2)(100.0)    
Hemoadsorption7625351039730512214611 6211671 788316147
(%)(0.4)(0.4)(15.6)(31.5)(24.5)(18.8)(7.5)(0.9)(0.4)(0.1)(100.0)    
Home HD334940319411 14183224253134
(%)(2.1)(2.1)(34.8)(28.4)(22.0)(6.4)(2.8)(0.7)(0.7) (100.0)    
PD20391 4291 7539738183838433105 5423 6229 164301173
(%)(0.4)(0.7)(25.8)(31.6)(17.6)(14.8)(6.9)(1.5)(0.6)(0.2)(100.0)    
Total846324674 79180 87142 63425 99785901581641305239 50242 494281 996267148
(%)(0.4)(1.4)(31.2)(33.8)(17.8)(10.9)(3.6)(0.7)(0.3)(0.1)(100.0)    

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

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

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

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

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

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

Administration or non-administration of phosphate binders (Tables 35,36)
Table 35. Use of phosphate binders for different dialysis methods (for all dialysis patients)
Use of phosphate bindersDialysis methodsTotal(%)
Facility HD(%)HDF(%)HF(%)Hemoadsorption(%)Home HD(%)PD(%)
  • Percentage relative to total in each column. HD, hemodialysis; HDF, hemodiafiltration; HF, hemofiltration; PD, peritoneal dialysis.

Calcium carbonate (CaCO3) only82 359(39.2)4 859(34.6)8(18.6)574(37.2)57(40.7)2070(34.1)89 927(38.8)
Sevelamer HCl (Sevelamer) only20 187(9.6)1 771(12.6)2(4.7)249(16.1)22(15.7)668(11.0)22 899(9.9)
Lanthanum carbonate (La2(CO3)3) only8 849(4.2)904(6.4)1(2.3)78(5.0)5(3.6)229(3.8)10 066(4.3)
CaCO3 + Sevelamer27 571(13.1)2 195(15.6)0(0.0)264(17.1)20(14.3)820(13.5)30 870(13.3)
CaCO3 + La2(CO3)39 777(4.7)882(6.3)9(20.9)84(5.4)4(2.9)228(3.8)10 984(4.7)
Sevelamer + La2(CO3)33 961(1.9)501(3.6)2(4.7)47(3.0)2(1.4)82(1.4)4 595(2.0)
All three4 064(1.9)395(2.8)1(2.3)26(1.7)4(2.9)118(1.9)4 608(2.0)
None53 321(25.4)2 531(18.0)20(46.5)223(14.4)26(18.6)1852(30.5)57 973(25.0)
Total210 089(100.0)14 038(100.0)43(100.0)1545(100.0)140(100.0)6067(100.0)231 922(100.0)
Table 36. Predialysis serum phosphorus levels (mg/dL) in patients administered or not administered phosphate binders (for patients who underwent HD at facilities three times per week)
Use of phosphate bindersPredialysis serum phosphorus levels (mg/dL)SubtotalNo information availableTotal
<2.02.0∼3.5∼4.8∼6.1∼7.0∼8.0∼9.0∼
Calcium carbonate (CaCO3) only3048 53329 08125 3598 9463 920124771778 10764178 748
(%)(0.4)(10.9)(37.2)(32.5)(11.5)(5.0)(1.6)(0.9)(100.0)  
Sevelamer HCl (Sevelamer) only351 1705 5407 3093 0261 52257233219 50612119 627
(%)(0.2)(6.0)(28.4)(37.5)(15.5)(7.8)(2.9)(1.7)(100.0)  
Lanthanum carbonate (La2(CO3)3) only205362 2892 6821 4268873942238 457938 550
(%)(0.2)(6.3)(27.1)(31.7)(16.9)(10.5)(4.7)(2.6)(100.0)  
CaCO3 + Sevelamer571 2927 3419 9684 6622 21479246026 78613926 925
(%)(0.2)(4.8)(27.4)(37.2)(17.4)(8.3)(3.0)(1.7)(100.0)  
CaCO3 + La2(CO3)3144792 5983 0051 6329494592699 405499 454
(%)(0.1)(5.1)(27.6)(32.0)(17.4)(10.1)(4.9)(2.9)(100.0)  
Sevelamer + La2(CO3)391699931 3456953791461043 840193 859
(%)(0.2)(4.4)(25.9)(35.0)(18.1)(9.9)(3.8)(2.7)(100.0)  
All three101498821 3177424741961603 930113 941
(%)(0.3)(3.8)(22.4)(33.5)(18.9)(12.1)(5.0)(4.1)(100.0)  
None7129 24617 95612 6554 2391 92869349147 92091748 837
(%)(1.5)(19.3)(37.5)(26.4)(8.8)(4.0)(1.4)(1.0)(100.0)  
Total116121 57466 68063 64025 36812 27344992756197 9511990199 941
(%)(0.6)(10.9)(33.7)(32.1)(12.8)(6.2)(2.3)(1.4)(100.0)  

Table 35 shows the results of the administration or non-administration of phosphate binders for different dialysis methods. In this table, only the patients who provided answers other than “unspecified” to all the questions regarding calcium carbonate, sevelamer HCl, and lanthanum carbonate were targeted. Calcium carbonate was the most commonly used among the phosphate binders (i.e. administered to 58.8% of all the target patients). The percentage of patients administered calcium carbonate among the patients who underwent HD at facilities (referred to as facility HD patients) was 58.9%, which was greater than the percentage among PD patients (53.3%). The percentages of patients exclusively administered calcium carbonate, sevelamer HCl, or lanthanum carbonate were 53.0% for the facility HD patients and 48.9% for the PD patients. Namely, these phosphate binders were more commonly used among the facility HD patients than among the PD patients. The percentage of patients administered all of the above three phosphate binders was 1.9% for both the facility HD and PD patients; there were no differences between them and the percentages were small. The percentages of patients not administered the three phosphate binders were 25.4% for the facility HD patients and 30.5% for the PD patients. The above three phosphate binders were less commonly used among the PD patients than among the facility HD patients.

Table 36 shows the predialysis serum phosphorus levels in patients administered and not administered phosphate binders and who underwent HD at facilities three times per week. The predialysis serum phosphorus levels recommended in the CKD-MBD Guidelines (1) (3.5–6.0 mg/dL) were satisfied in 69.7% of the patients administered only calcium carbonate, 65.9% of the patients administered only sevelamer HCl, and 58.8% of the patients administered only lanthanum carbonate. Such recommended levels were also satisfied in 56.0% of the patients administered all of the above three phosphate binders and 63.9% of the non-administered patients. Moreover, 20.8% of the non-administered patients showed a low serum phosphorus level of less than 3.5 mg/dL.

Administration or non-administration of vitamin D and cinacalcet (Tables 37–40)
Table 37. Patients administered or not administered with oral vitamin D for different dialysis methods (for all dialysis patients)
Dialysis methodUse of oral vitamin DSubtotalUnspecifiedNo information availableTotal
NonuseUse
  1. 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.

Facility HD131 31981 113212 432149139 884253 807
(%)(61.8)(38.2)(100.0)   
HDF8 9355 22914 164472 64216 853
(%)(63.1)(36.9)(100.0)   
HF325082078160
(%)(39.0)(61.0)(100.0)   
Hemoadsorption1 0045521 55662261 788
(%)(64.5)(35.5)(100.0)   
Home HD5093143180224
(%)(35.0)(65.0)(100.0)   
PD2 9663 1946 160632 9419 164
(%)(48.1)(51.9)(100.0)   
Total144 30690 231234 537160845 851281 996
(%)(61.5)(38.5)(100.0)   
Table 38. Patients administered or not administered intravenous vitamin D for different dialysis methods (for all dialysis patients)
Dialysis methodUse of intravenous vitamin DSubtotalUnspecifiedNo information availableTotal
Had never been administeredUnder administrationAdministered previously
  1. 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.

Facility HD140 32054 1359 633204 088780341 916253 807
(%)(68.8)(26.5)(4.7)(100.0)   
HDF7 7774 9011 04113 7195182 61616 853
(%)(56.7)(35.7)(7.6)(100.0)   
HF27112403117160
(%)(67.5)(27.5)(5.0)(100.0)   
Hemoadsorption7276021521 481642431 788
(%)(49.1)(40.6)(10.3)(100.0)   
Home HD110198137780224
(%)(80.3)(13.9)(5.8)(100.0)   
PD5 252327715 6504983 0169 164
(%)(93.0)(5.8)(1.3)(100.0)   
Total154 21359 99510 907225 115889347 988281 996
(%)(68.5)(26.7)(4.8)(100.0)   
Table 39. Patients administered or not administered cinacalcet for different dialysis methods (for all dialysis patients)
Dialysis methodUse of cinacalcetSubtotalUnspecifiedNo information availableTotal
Had never been administeredHad been administered for at least one yearHad been administered for less than one yearHad been administered but discontinued
  1. 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.

Facility HD183 48514 62977881632207 534428241 991253 807
(%)(88.4)(7.0)(3.8)(0.8)(100.0)   
HDF10 8201 98292218413 9082422 70316 853
(%)(77.8)(14.3)(6.6)(1.3)(100.0)   
HF38400421117160
(%)(90.5)(9.5)(0.0)(0.0)(100.0)   
Hemoadsorption1 137260126201 54392361 788
(%)(73.7)(16.9)(8.2)(1.3)(100.0)   
Home HD8343150141380224
(%)(58.9)(30.5)(10.6)(0.0)(100.0)   
PD5 123433245275 8283602 9769 164
(%)(87.9)(7.4)(4.2)(0.5)(100.0)   
Total200 68617 35190961863228 996489748 103281 996
(%)(87.6)(7.6)(4.0)(0.8)(100.0)   
Table 40. Serum intact-parathyroid hormone (PTH) levels (pq/mL) in patients administered or not administered cinacalcet (patients who underwent HD at facilities three times per week)
Use of cinacalcetSerum intact-PTH levels (pq/mL)SubtotalNo information availableTotalMeanSD
<3131∼61∼121∼181∼361∼721∼1441∼
  1. The values in parentheses under each figure represent the percentage relative to the total in each row.

Had never been administered16 86519 40036 51328 16732 3947 4421009146141 9363727145 663150147
(%)(11.9)(13.7)(25.7)(19.8)(22.8)(5.2)(0.7)(0.1)(100.0)    
Had been administered for at least one year2586792 6172 7313 9241 4953345512 0938912 182232216
(%)(2.1)(5.6)(21.6)(22.6)(32.4)(12.4)(2.8)(0.5)(100.0)    
Had been administered for less than one year1743481 1951 2812 250982185316 446346 480248223
(%)(2.7)(5.4)(18.5)(19.9)(34.9)(15.2)(2.9)(0.5)(100.0)    
Had been administered but discontinued11010517119339825475171 32351 328292341
(%)(8.3)(7.9)(12.9)(14.6)(30.1)(19.2)(5.7)(1.3)(100.0)    
Subtotal17 40720 53240 49632 37238 96610 1731603249161 7983855165 653161162
(%)(10.8)(12.7)(25.0)(20.0)(24.1)(6.3)(1.0)(0.2)(100.0)    
Unspecified2673005654845231112232 2751552 430152156
(%)(11.7)(13.2)(24.8)(21.3)(23.0)(4.9)(1.0)(0.1)(100.0)    
No information available8191 0062 1081 6972 296756111158 80810869 894177172
(%)(9.3)(11.4)(23.9)(19.3)(26.1)(8.6)(1.3)(0.2)(100.0)    
Total18 49321 83843 16934 55341 78511 0401736267172 8815096177 977162163
(%)(10.7)(12.6)(25.0)(20.0)(24.2)(6.4)(1.0)(0.2)(100.0)    

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

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

The percentage of patients administered cinacalcet showed an insignificant difference between the facility HD and PD patients (Table 39).

Table 40 shows serum intact-PTH levels in patients administered or not administered cinacalcet and who underwent HD at facilities three times per week. The serum intact-PTH levels in the patients who were administered cinacalcet at the time of the survey and those who had previously received cinacalcet were higher than those of the patients who had never been administered cinacalcet. The serum intact-PTH levels recommended in the CKD-MBD Guidelines (61–180 pg/mL) were satisfied in 41.2% of the patients who currently and previously received cinacalcet compared with 45.6% among patients who had never received the drug.

Current status of satisfaction of target levels during therapy recommended in CKD-MBD Guidelines (Tables 41,42)
Table 41. Predialysis serum phosphorus levels (mg/dL) in relation to predialysis corrected serum calcium levels (mg/dL) (for all dialysis patients)
Predialysis corrected serum calcium levels (mg/dL)Predialysis serum phosphorus levels (mg/dL)SubtotalNo information availableTotalMeanSD
0.1∼3.5∼6.1∼
  1. The values in parentheses under each figure represent the percentage relative to the total.

5.0∼2 04914 2465 83822 1331722 1505.201.61
(0.8)(5.9)(2.4)(9.1)    
8.4∼20 939122 82839 158182 92594183 0195.011.43
(8.6)(50.6)(16.1)(75.4)    
10.1∼5 16022 9919 45837 6092637 6355.091.54
(2.1)(9.5)(3.9)(15.5)    
Subtotal28 148160 06554 454242 667137242 8045.041.47
(11.6)(66.0)(22.4)(100.0)    
No information available6874 0422 0276 75632 43639 1925.371.63
Total28 835164 10756 481249 42332 573281 9965.051.47
Mean9.419.299.339.319.279.31  
SD0.950.850.960.891.330.89  
Table 42. Current status of satisfaction of target values of parameters recommended by chronic kidney disease-mineral and bone disorder (CKD-MBD) Guidelines
 Extraction conditionsNumber of patients(%)
  1. Target patients refer to those who responded to the questions regarding predialysis phosphorus, predialysis corrected serum calcium, and intact-PTH levels. Percentage relative to total number of target patients.

1)Predialysis serum phosphorus level = 3.5–6.0 mg/dL128 811(66.0)
2)Predialysis corrected serum calcium level = 8.4–10.0 mg/dL147 152(75.4)
3)Serum intact-parathyroid hormone (PTH) level = 60–180 pg/mL88 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 calcium level = 8.4–10.0 mg/dL, and serum intact-parathyroid hormone (PTH) level = 60–180 pg/mL48 418(24.8)
 Total number of target patients195 256(100.0)

Figure 2 shows the target corrected serum calcium and serum phosphorus levels during therapy recommended in the CKD-MBD Guidelines (1). Table 41 shows the predialysis corrected serum calcium and serum phosphorus levels for all the dialysis patients to evaluate the current status of satisfaction of levels recommended in the CKD-MBD Guidelines. The percentage of patients who satisfied both the recommended corrected serum calcium and serum phosphorus levels was 50.6%.

image

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

Download figure to PowerPoint

Table 42 shows the current status of satisfaction of the values recommended in the CKD-MBD Guidelines (1) considering the serum intact-PTH level as well as corrected serum calcium and serum phosphorus levels. The percentage of patients who satisfied the corrected serum calcium, serum phosphorus, and serum intact-PTH levels recommended in the guidelines was 24.8%

Items associated with dementia

Complications of dementia

The association between dialysis therapies and the onset of dementia has not been clearly demonstrated. Previously, there was a time when dialysis encephalopathy developed owing to the accumulation of aluminum in the brain of dialysis patients, which was considered to be a serious problem. Because reverse osmosis systems have become widespread, however, dialysis encephalopathy has rarely been observed as a complication of dialysis patients in recent years. Under such circumstances, there have been no reports, as far as we know, in which the relationship between dialysis therapies and the onset of dementia was examined in a large number of dialysis patients.

In the 2009 survey, the onset or non-onset of dementia was investigated. This item was asked with the following four alternatives, and the judgment was left to respondents.

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

Dialysis method and dementia (Table 43).  Patients determined to have dementia (patients with dementia) accounted for 9.8% of all the dialysis patients. The percentage of patients with dementia among the patients who underwent hemofiltration was 20.4%, the highest percentage among different dialysis methods. In contrast, no patients with dementia were observed among those who underwent HD at home. The ratio of the percentage of patients with dementia requiring no care to that of patients with dementia requiring care was approximately 1 : 1.

Table 43. Numbers of patients with and without dementia for different dialysis methods (for all dialysis patients)
Dialysis methodDementiaSubtotalUnspecifiedNo information availableTotal
Without dementiaWith dementia (requiring no care)With dementia (requiring care)
  1. 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.

Facility HD185 251931711 944206 512262644 669253 807
(%)(89.7)(4.5)(5.8)(100.0)   
HDF13 04141146613 918962 83916 853
(%)(93.7)(3.0)(3.3)(100.0)   
HF3572441115160
(%)(79.5)(15.9)(4.5)(100.0)   
Hemoadsorption1 50916131 53872431 788
(%)(98.1)(1.0)(0.8)(100.0)   
Home HD14400144080224
(%)(100.0)(0.0)(0.0)(100.0)   
PD5 5351251965 8561163 1929 164
(%)(94.5)(2.1)(3.3)(100.0)   
Total205 515987612 621228 012284651 138281 996
(%)(90.1)(4.3)(5.5)(100.0)   

As shown in the following pages, the onset of dementia is largely affected by age and the complications of diabetes and cerebrovascular disease. Because such background factors in patients were not considered in the above tabulation results for different dialysis methods, each dialysis method cannot be associated with the risk of the onset of dementia. The tabulation results should be interpreted as indicating the adaptation status of each dialysis method to patients with dementia.

Gender and dementia (Table 44). Table 44 shows the numbers of patients with and without dementia who underwent HD at facilities three times per week for both genders. The percentage of patients with dementia was greater among females than males

Table 44. Numbers of patients with and without dementia for both genders (for patients who underwent HD at facilities three times per week)
GenderDementiaSubtotalUnspecifiedNo information availableTotal
Without dementiaWith dementia (requiring no care)With dementia (requiring care)
  1. The values in parentheses under each figure represent the percentage relative to the total in each row.

Male112 05549135 398122 366147414 657138 497
(%)(91.6)(4.0)(4.4)(100.0)   
Female64 81537955 59474 2049868 88484 074
(%)(87.3)(5.1)(7.5)(100.0)   
Subtotal176 870870810 992196 570246023 541222 571
(%)(90.0)(4.4)(5.6)(100.0)   
No information available0000000
(%)       
Total176 870870810 992196 570246023 541222 571
(%)(90.0)(4.4)(5.6)(100.0)   

Age and dementia (Table 45). Table 45 shows the numbers of patients with and without dementia who underwent HD at facilities three times per week for different ages. For patients aged 60 years or older, the percentage of patients with dementia increased with age

Table 45. Numbers of patients with and without dementia and their ages (for patients who underwent HD at facilities three times per week)
Age (years old)DementiaSubtotalUnspecifiedNo information availableTotal
Without dementiaWith dementia (requiring no care)With dementia (requiring care)
  1. The values in parentheses under each figure represent the percentage relative to the total in each row.

<154105005
(%)(80.0)(20.0)(0.0)(100.0)   
15–2990575917101121 039
(%)(98.7)(0.8)(0.5)(100.0)   
30–4410 818313510 884901 37412 348
(%)(99.4)(0.3)(0.3)(100.0)   
45–5941 69735632842 3814155 11747 913
(%)(98.4)(0.8)(0.8)(100.0)   
60–7483 62629553 16989 750116810 817101 735
(%)(93.2)(3.3)(3.5)(100.0)   
75–8938 54150316 80150 3737315 87256 976
(%)(76.5)(10.0)(13.5)(100.0)   
90–1 2783276532 258462492 553
(%)(56.6)(14.5)(28.9)(100.0)   
Subtotal176 869870810 991196 568246023 541222 569
(%)(90.0)(4.4)(5.6)(100.0)   
No information available1012002
(%)(50.0)(0.0)(50.0)(100.0)   
Total176 870870810 992196 570246023 541222 571
(%)(90.0)(4.4)(5.6)(100.0)   
Mean64.8075.9277.4866.0068.2665.7966.00
SD12.258.978.8812.4911.9912.4712.49

Primary diseases and dementia (Table 46). Table 46 shows the numbers of patients with and without dementia who underwent HD at facilities three times per week for different primary diseases. The percentage of patients with dementia among the patients with diabetic nephropathy as the primary disease (11.6%) was greater than that among the patients with chronic glomerulonephiritis as the primary disease (7.5%). A study of dementia in the general population, not dialysis patients, also indicates that diabetes is related to the onset of dementia (7).

Table 46. Numbers of patients with and without dementia and their primary diseases (for patients who underwent HD at facilities three times per week)
Primary diseaseDementiaSubtotalUnspecifiedNo information availableTotal
Without dementiaWith dementia (requiring no care)With dementia (requiring care)
  1. The values in parentheses under each figure represent the percentage relative to the total in each row. SLE, systemic lupus erythematosus.

Chronic glomerulonephritis66 68324442 94972 0767558 58481 415
(%)(92.5)(3.4)(4.1)(100.0)   
Chronic pyelonephritis1 93875842 097252262 348
(%)(92.4)(3.6)(4.0)(100.0)   
Rapidly progressive glomerulonephritis1 19160791 330161541 500
(%)(89.5)(4.5)(5.9)(100.0)   
Nephropathy of pregnancy/pregnancy toxemia1 13523201 178131611 352
(%)(96.3)(2.0)(1.7)(100.0)   
Other nephritides that cannot be classified7943035859171341 010
(%)(92.4)(3.5)(4.1)(100.0)   
Polycystic kidney6 3461711836 700777997 576
(%)(94.7)(2.6)(2.7)(100.0)   
Nephrosclerosis11 89010101 34614 2461731 62116 040
(%)(83.5)(7.1)(9.4)(100.0)   
Malignant hypertension1 40452671 523111821 716
(%)(92.2)(3.4)(4.4)(100.0)   
Diabetic nephropathy63 39136934 64071 7249288 36581 017
(%)(88.4)(5.1)(6.5)(100.0)   
SLE nephritis1 47840511 569111721 752
(%)(94.2)(2.5)(3.3)(100.0)   
Amyloidal kidney3231310346542393
(%)(93.4)(3.8)(2.9)(100.0)   
Gouty kidney8173537889121011 002
(%)(91.9)(3.9)(4.2)(100.0)   
Renal failure due to congenital abnormality of metabolism17330176126203
(%)(98.3)(1.7)(0.0)(100.0)   
Kidney and urinary tract tuberculosis2031814235030265
(%)(86.4)(7.7)(6.0)(100.0)   
Kidney and urinary tract stone3701616402742451
(%)(92.0)(4.0)(4.0)(100.0)   
Kidney and urinary tract tumor4602623509468581
(%)(90.4)(5.1)(4.5)(100.0)   
Obstructive urinary tract disease4151419448347498
(%)(92.6)(3.1)(4.2)(100.0)   
Myeloma122126140113154
(%)(87.1)(8.6)(4.3)(100.0)   
Hypoplastic kidney34864358449411
(%)(97.2)(1.7)(1.1)(100.0)   
Undetermined12 7747881 17314 7352952 04017 070
(%)(86.7)(5.3)(8.0)(100.0)   
Reintroduction after transplantation1 23920251 284421561 482
(%)(96.5)(1.6)(1.9)(100.0)   
Others3 3621592113 732604854 277
((%))(90.1)(4.3)(5.7)(100.0)   
Subtotal176 856870810 992196 556246023 497222 513
(%)(90.0)(4.4)(5.6)(100.0)   
No information available14001404458
(%)(100.0)(0.0)(0.0)(100.0)   
Total176 870870810 992196 570246023 541222 571
(%)(90.0)(4.4)(5.6)(100.0)   

Histories of cerebrovascular disease and dementia (Tables 47,48). Tables 47,48 show the numbers of patients with and without dementia who underwent HD at facilities three times per week, and their histories of cerebral infarction and cerebral hemorrhage, respectively. For both cerebral infarction and cerebral hemorrhage, the percentage of patients with dementia was greater in the patients who had histories of these diseases than in the patients who did not.

Table 47. Numbers of patients with and without dementia and their history of cerebral infarction (for patients who underwent HD at facilities three times per week)
History of cerebral infarctionDementiaSubtotalUnspecifiedNo information availableTotal
Without dementiaWith dementia (requiring no care)With dementia (requiring care)
  1. The values in parentheses under each figure represent the percentage relative to the total in each row.

No147 98955826 173159 7449731 599162 316
(%)(92.6)(3.5)(3.9)(100.0)   
Yes18 07322273 59323 89348259324 968
(%)(75.6)(9.3)(15.0)(100.0)   
Acute, Under treatment81172412245131
(%)(66.4)(13.9)(19.7)(100.0)   
With lacunar infarction2 7263334643 52321693 613
(%)(77.4)(9.5)(13.2)(100.0)   
Subtotal168 869815910 254187 28214802 266191 028
(%)(90.2)(4.4)(5.5)(100.0)   
Unspecified857991751 13126841 403
(%)(75.8)(8.8)(15.5)(100.0)   
No information available7 1444505638 15771221 27130 140
(%)(87.6)(5.5)(6.9)(100.0)   
Total176 870870810 992196 570246023 541222 571
(%)(90.0)(4.4)(5.6)(100.0)   
Table 48. Numbers of patients with and without dementia and their history of cerebral hemorrhage (for patients who underwent HD at facilities three times per week)
History of cerebral hemorrhageDementiaSubtotalUnspecifiedNo information availableTotal
Without dementiaWith dementia (requiring no care)With dementia (requiring care)
  1. The values in parentheses under each figure represent the percentage relative to the total in each row.

No162 32275139 095178 93011681 742181 840
(%)(90.7)(4.2)(5.1)(100.0)   
Yes6 8576561 1508 6632712199 153
(%)(79.2)(7.6)(13.3)(100.0)   
Acute, Under treatment585157810593
(%)(74.4)(6.4)(19.2)(100.0)   
Subtotal169 237817410 260187 67114491 966191 086
(%)(90.2)(4.4)(5.5)(100.0)   
Unspecified518611277062644974
(%)(73.4)(8.6)(18.0)(100.0)   
No information available7 1154736058 19374721 57130 511
(%)(86.8)(5.8)(7.4)(100.0)   
Total176 870870810 992196 570246023 541222 571
(%)(90.0)(4.4)(5.6)(100.0)   
Activities of daily living

Activities of daily living (ADL) of patients was previously investigated twice (current status of care in the 1998 survey and physical activities in the 2002 survey) (8,9).

The tabulation results on ADL are summarized in this section. Table 49 shows the alternatives used in the questionnaires and headings in the subsequent tables.

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 onset of the diseases without restrictions.[RIGHTWARDS ARROW]No symptoms
B:The patient has moderate symptoms and has trouble with physical work, but can walk and do light and sedentary work, such as light domestic and clerical work.[RIGHTWARDS ARROW]Moderate symptoms
C:The patient can walk and take care of him/herself, but sometimes requires care. The patient can sit up at least half of the day although he/she cannot do light work.[RIGHTWARDS ARROW]≥50% sitting up
D:The patient can take care of him/herself to some extent, but often requires care and is in bed at least half of the day.[RIGHTWARDS ARROW]≥50% in bed
E:The patient cannot take care of him/herself and has to be in bed the whole day, requiring constant care.[RIGHTWARDS ARROW]Whole day in bed
Z:Unspecified or uncategorized[RIGHTWARDS ARROW]Unspecified

Dementia and ADL (Table 50). Table 50 shows the numbers of patients with and without dementia who underwent HD at facilities three times per week for different levels of ADL. There was a tendency that the percentage of patients with dementia tended to be higher in the group with a low level of ADL

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 livingDementiaSubtotalUnspecifiedNo information availableTotal
Without dementiaWith dementia (requiring no care)With dementia (requiring care)
  1. The values in parentheses under each figure represent the percentage relative to the total in each row.

No symptoms86 25881330187 37217761788 166
(%)(98.7)(0.9)(0.3)(100.0)   
Moderate symptoms53 988196763856 59313781257 542
(%)(95.4)(3.5)(1.1)(100.0)   
≥50(%) sitting up19 64729262 33124 90418831125 403
(%)(78.9)(11.7)(9.4)(100.0)   
≥50(%) in bed8 90817052 87613 48913612113 746
(%)(66.0)(12.6)(21.3)(100.0)   
Whole day in bed4 49211534 64910 29453713810 969
(%)(43.6)(11.2)(45.2)(100.0)   
Subtotal173 293856410 795192 65211751 999195 826
(%)(90.0)(4.4)(5.6)(100.0)   
Unspecified6843485803127272 082
(%)(85.2)(4.2)(10.6)(100.0)   
No information available2 8931101123 1151321 53524 663
(%)(92.9)(3.5)(3.6)(100.0)   
Total176 870870810 992196 570246023 541222 571
(%)(90.0)(4.4)(5.6)(100.0)   
Place of residence

In this survey, the place of residence of individual patients was investigated using the following four alternatives.

A: Patients' own home (outpatient dialysis, home PD, home HD).

B: Care facilities (e.g. homes with care services, nursing homes such as private-pay nursing homes without national aids and nursing homes for families with financial difficulties, group homes, vocational centers, relief facilities).

C: Hospitals (e.g. health service facilities for elderly; beds for general patients, patients of chronic stage, patients requiring rehabilitation, and patients with mental illness and infectious diseases, such as tuberculosis).

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 patients and their places of residence for different dialysis methods. Hemofiltration showed the highest percentage of patients who stayed at hospitals and care facilities, whereas HD at home showed the lowest percentage of such patients.

Table 51. Places of residence for different dialysis methods (for all dialysis patients)
Dialysis methodPlaces of residenceSubtotalUnspecifiedNo information availableTotal
HomesCare facilitiesHospitals§
  1. The values in parentheses under each figure represent the percentage relative to the total in each row. Patients' own home (outpatient dialysis, home PD, home HD). Care facilities (e.g. homes with care services, nursing homes such as private-pay nursing homes without national 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 with mental illness and infectious diseases, such as tuberculosis).

Facility HD186 469430817 945208 722138543 700253 807
(%)(89.3)(2.1)(8.6)(100.0)   
HDF13 16116470114 026512 77616 853
(%)(93.8)(1.2)(5.0)(100.0)   
HF3037401119160
(%)(75.0)(7.5)(17.5)(100.0)   
Hemoadsorption1 48411381 533162391 788
(%)(96.8)(0.7)(2.5)(100.0)   
Home HD14401145079224
(%)(99.3)(0.0)(0.7)(100.0)   
PD5 645352325 912913 1619 164
(%)(95.5)(0.6)(3.9)(100.0)   
Total206 933452118 924230 378154450 074281 996
(%)(89.8)(2.0)(8.2)(100.0)   

ADL and place of residence (Table 52). Table 52 shows the number of patients and their places of residence who underwent HD at facilities three times per week for different levels of ADL. The percentages of patients who stayed at hospitals and care facilities tended to be higher among patients with a low level of ADL

Table 52. ADL for different places of residence (for patients who underwent HD at facilities three times per week)
Places of residenceActivities of daily living (ADL)SubtotalUnspecifiedNo information availableTotal
No symptomsModerate symptoms≥50% sitting up≥50% in bedWhole day in bed
  1. The values in parentheses under each figure represent the percentage relative to the total in each row. Patients' own home (outpatient dialysis, home peritoneal dialysis [PD], home HD). Care facilities (e.g. homes with care services, nursing homes such as private-pay nursing homes without national 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 with mental illness and infectious diseases, such as tuberculosis).

Homes86 80355 43521 0528 2923 264174 8467432 390177 979
(%)(49.6)(31.7)(12.0)(4.7)(1.9)(100.0)   
Care facilities4155631 1419888143 92134494 004
(%)(10.6)(14.4)(29.1)(25.2)(20.8)(100.0)   
Hospitals§6331 2753 0844 4036 84816 24318817616 607
(%)(3.9)(7.8)(19.0)(27.1)(42.2)(100.0)   
Subtotal87 85157 27325 27713 68310 926195 0109652 615198 590
(%)(45.0)(29.4)(13.0)(7.0)(5.6)(100.0)   
Unspecified15012121610200111511 316
(%)(75.0)(6.0)(6.0)(8.0)(5.0)(100.0)   
No information available1652571144733616222 04722 665
(%)(26.8)(41.7)(18.5)(7.6)(5.4)(100.0)   
Total88 16657 54225 40313 74610 969195 826208224 663222 571
(%)(45.0)(29.4)(13.0)(7.0)(5.6)(100.0)   

Dementia and place of residence (Table 53). Table 53 shows the numbers of patients with and without dementia who underwent HD at facilities three times per week and their places of residence. The percentage of patients with dementia was high among those who stayed at hospitals and care facilities.

Table 53. Numbers of patients with and without dementia and their places of residence (for patients who underwent HD at facilities three times per week)
Places of residenceDementiaSubtotalUnspecifiedNo information availableTotal
Without dementiaWith dementia (requiring no care)With dementia (requiring care)
  1. The values in parentheses under each figure represent the percentage relative to the total in each row. Patients' own home (outpatient dialysis, home peritoneal dialysis [PD], home HD). Care facilities (e.g. homes with care services, nursing homes such as private-pay nursing homes without national 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 with mental illness and infectious diseases, such as tuberculosis).

Homes163 40860505 188174 6466562 677177 979
(%)(93.6)(3.5)(3.0)(100.0)   
Care facilities2 2135331 1423 88864524 004
(%)(56.9)(13.7)(29.4)(100.0)   
Hospitals§9 12220114 57415 70763626416 607
(%)(58.1)(12.8)(29.1)(100.0)   
Subtotal174 743859410 904194 24113562 993198 590
(%)(90.0)(4.4)(5.6)(100.0)   
Unspecified200412216110001 316
(%)(92.6)(1.9)(5.6)(100.0)   
No information available1 927110762 113420 54822 665
(%)(91.2)(5.2)(3.6)(100.0)   
Total176 870870810 992196 570246023 541222 571
(%)(90.0)(4.4)(5.6)(100.0)   

Acknowledgment

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES

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

District Cooperative Committee:  Noritomo Itami, Akishi Momose, Koji Seino, Kazuyuki Suzuki, Tomoyoshi Kimura, Shigeru Sato, Ikuto Masakane, Minoru Ito, Tsuyoshi Watanabe, Kunihiro Yamagata, Eiji Kusano, Shigeaki Muto, Hironobu Kawai, Hiromichi Suzuki, Kaoru Tabei, Noriyoshi Muroya, Takahiro Mochizuki, Masanori Abe, Ryoichi Ando, Akira Ishikawa, Kazuyoshi Okada, Satoru Kuriyama, Tsutomu Sanaka, Toshio Shinoda, Eisei Noiri, Matsuhiko Hayashi, Sonoo Mizuiri, Koujyu Kamata, Eriko Kinugasa, Takatoshi Kakuta, Fumihiko Koiwa, Takeo Sato, Shinichi Nishi, Hiroki Maruyama, Hiroyuki Iida, Yoichi Ishida, Hitoshi Yokoyama, Chikashi Kito, Haruo Yamashita, Mizuya Fukasawa, Kazuhiko Hora, Shigeki Sawada, Hiroshi Oda, Akihiko Kato, Yuzo Watanabe, Yasuhiko Ito, Shinsuke Nomura, Katsunori Sawada, Tsuguru Hatta, Noriyuki Iwamoto, Masaki Kawamura, Yoshiaki Takemoto, Takeshi Nakanishi, Katsunori Yoshida, Takashi Shigematsu, Akihisa Nakaoka, Chishio Munemura, Takafumi Ito, Makoto Hiramatsu, Noriaki Yorioka, Hideyasu Matsuyama, Koichi Uchiyama, Hirofumi Hashimoto, Akira Numata, Atsumi Harada, Naotami Terao, Kenji Yuasa, Masahiko Nakamoto, Kei Hori, Toru Sanai, Takashi Harada, Kenji Arizono, Tadashi Tomo, Syoichi Fujimoto, Toru Ikeda, Shigeki Toma, Akira Higa, Kunio Yoshihara.

REFERENCES

  1. Top of page
  2. Abstract
  3. Is it necessary to conduct such surveys that require troublesome work?
  4. There are too many survey items
  5. Why are the survey items changed every year?
  6. Disclosure of survey items in advance is preferable
  7. Is it effective to conduct the survey every year?
  8. PATIENTS AND METHODS
  9. RESULTS AND DISCUSSION
  10. Acknowledgment
  11. REFERENCES