2003 Volume 36 Issue 1 Pages 1-31
Questionnaire forms for an annual survey of chronic dialysis therapy conducted at the end of 2001 were sent out to 3, 520 dialysis institutions, and 3, 485 replies were received (response rate, 99.00%). According to the survey, the dialysis population of Japan at yearend was 219, 183 patients, up 6.3% (13, 049) over the year before. This equals 1, 721.9 dialysis patients per million population. The gross mortality rate was 9.3% for the year extending from the end of 2000 to the end of 2001. The mean age of patients beginning dialysis was 64.2 years (±13.7 S. D.). The mean age of the overall dialysis population in the study year was 61.6 years (±13.1 S.D.), which was also a higher age than the year before. Among dialysis patients, the primary disease was diabetic nephropathy in 38.1% of patients, slightly down from 39.1% the previous year. Chronic glomerulonephritis was the primary disease in 32.4% of cases, a decrease from 34.7% the previous year.
This survey included for the first time the items of the lowest blood pressure during treatment, vasopressor therapy before dialysis and vasopressor therapy during dialysis.
An analysis of the relationship between the type of vascular access used at the initiation of dialysis and the survival prognosis revealed a significantly higher risk of death in patients undergoing dialysis with synthetic AV fistula, AV shunt, or catheter implantation into a central vein than in those receiving dialysis treatment with a native fistula. There was a significantly lower risk of death in the patient group in whom the vascular access was created at 3-6 months before initiation of dialysis than in those in whom such access was created at the time of initiation or within 3 months before the initiation of dialysis.
An analysis of the risk factors affecting survival prognosis in maintenance hemodialysis patients showed that risk factors for death are post-dialysis systolic blood pressure over 120mmHg and lower than 180mmHg, blood pressure elevating progressively from the start to the end of dialysis, serum HDL-cholesterol concentration of less than 30mg/dL, and higher ultrafiltration rate.
The results of a death risk comparison between a patient group with a history of intervention for ischemic heart disease and a patient group with a history of myocardial infarction or heart failure but without such intervention showed that, among diabetes patients, those who underwent PTCA had a significantly lower risk of death than did those in whom no intervention was made.
