Japan's total dialysis patient population at the end of the year 2001 was 219, 183, an increase of more than ten thousand over last few years. The annual crude mortality rate was more than 9%. The mean patient age at the initiation of dialysis treatment was increasing, and the mean age of the overall dialysis patient population was over 60 years. Among the primary diagnosis, the prevalence of diabetic nephropathy continued to increase to near 40%. Therefore, the number of dialysis patient population with several complications at the beginning of dialysis was supposed to increase. The quality of life and the survival rate offered by long-term hemodialytic therapy varies in patients depending on several factors including age, renal diagnosis, comorbid conditions (diabetes, cardiovascular disease), nutritional status and so on. In this paper, I focus on several complications among the many complications of chronic hemodialysis, such as cardiovascular disease, amyloidosis and vascular access complications.

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Loss of ultrafiltration (UF loss) is a major cause of discontinuing long-term peritoneal dialysis. The peritoneal angiogenesis is assumed to cause peritoneal hyperpermeability, and result in UF loss. Factors affecting peritoneal angiogenesis are peritonitis, dialysis failure, chronic inflammation, and bio-incompatibility of dialysis solutions. The new solutions (such as Glucose polymercontaining solutions, neutralized solutions) are anticipated to ameliorate UF loss. Encapsulating peritoneal sclerosis (EPS) is the most serious complication of continuous ambulatory peritoneal dialysis. It is thought to be most important to anticipate UF loss for prevention of EPS.

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Among the patients under 60 years old receiving dialysis, 81.9% are still working. The modality of dialysis does not influence social activity. Only 54.3% of patients with diabetic nephropathy work because of various complications. Cerebrovascular disease is a major cause of death of patients receiving dialysis in Japan. Intensive care at the acute phase and early initiation of rehabilitation prevent death and disability. Ischemic heart disease is also a common complication. Recently, the number of cases receiving coronary intervention and coronary bypass has been increasing.

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An increase in the number of dialysis patients and their aging pose a problem in Japan.
Moreover, in connection with it, several authors report an increase in the number of inpatients and the burden placed on care workers.
From this background, QOL research has been developing in the field of Japanese dialysis treatment. SF-36 and KDQOL are worldwide health survey questionnaires and have already been introduced in Japan. Representative papers about QOL research among dialysis patients based on SF-36 and KDQOL are introduced.
On the other hand, since dialysis treatment is a kind of life-prolongation treatment, the withholding or withdrawal of dialysis treatment should be discussed ethically and carefully. Representative papers dealing with advance directives (Living Will) and withdrawal of dialysis are also introduced.

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The 3 year plan for medical care and clinical research of the Policy-Based Medical Service Network of Renal Disease (The Renal-net) among the National Hospitals, and the renal disease database and the pathological conference system are presented in this paper.
Also, recent findings of clinical research of IgA nephropathy and diabetic nephropathy are given in part. The Renal-Net in the national hospitals has been playing an important role in the field of daily medical treatment and cooperative clinical research is advancing to establish the EBM for the purpose of the preventing ESRD (end stage of renal disease).

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In Japan, end stage renal disease (ESRD) patients who undergo renal replacement therapy receive significant economic support from the medical insurance system, because it is anticipated that they will recover socially and be able to pay back the support they received for to society. But some reports have pointed out that the social recovery rate is extremely low for hemodialysis patients (30-50%), and therefore, this finatial support for such patients is threatening the medical insurance system.
Recently, “Jin-net (renal disease network)” has been established by national hospitals from Hokkaido to Kyushu, in order to carry out a nationwide study of nephrology. Renal disease network “Jin-net” should, and can, reveal the actual state of social recovery of ESRD patients, and provide some useful clues to resolve this difficult problem.

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This special program has resulted in a proposal of several concrete ideas to solve the dilemma between the cut of the government's ESRD (end stage renal disease) budget and the high cost of medical treatment for ERSD. The main proposal is an improvement of the present kidney replacement therapy concerning the medical cost and technology and the consequent increase in the level of QOL. From this point of view, peritoneal dialysis and kidney transplantation, especially cadaver, are suspected to be the most practical and effective replacement therapy for ERSD. The members who participate in the Kidney Network Project of Government's Policy in National Hospital's group can assemble concrete data in order to implement the aforementioned two replacement therapies.

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