A nationwide survey of 4,325 dialysis facilities was conducted at the end of 2013, among which 4,268 (98.7%) responded. The number of new dialysis patients was 38,095 in 2013. Since 2008, the number of new dialysis patients has remained almost the same without any marked increase or decrease. The number of dialysis patients who died in 2013 was 30,751. The dialysis patient population has been growing every year in Japan; it was 314,438 at the end of 2013. The number of dialysis patients per million at the end of 2013 was 2,470. The crude death rate of dialysis patients in 2013 was 9.8%. The mean age of new dialysis patients was 68.7 years and the mean age of the entire dialysis patient population was 67.2 years. The most common primary cause of renal failure among new dialysis patients was diabetic nephropathy (43.8%). The actual number of new dialysis patients with diabetic nephropathy has almost been unchanged for the last few years. Diabetic nephropathy was also the most common primary disease among the entire dialysis patient population (37.6%), followed by chronic glomerulonephritis (32.4%). The percentage of dialysis patients with diabetic nephropathy has been increasing continuously, whereas the percentage of dialysis patients with chronic glomerulonephritis has been decreasing. The number of patients who underwent hemodiafiltration (HDF) at the end of 2013 was 31,371, a marked increase from that in 2012. This number is more than twice that at the end of 2011 and approximately 1.5 times the number at the end of 2012. In particular, the number of patients who underwent online HDF increased approximately fivefold over the last two years. Among 151,426 dialysis patients with primary causes of renal failure other than diabetic nephropathy, 10.8% had a history of diabetes. Among those with a history of diabetes, 26.8% used glycated albumin as an indicator of blood glucose level; and 33.0 and 27.6% were administered insulin and dipeptidyl peptidase (DPP)-4 inhibitor, respectively, as a medication of diabates. The facility survey showed that 9,392 patients underwent peritoneal dialysis (PD). The patient survey revealed that 1,920 of these PD patients also underwent another dialysis method using extracorporeal circulation, such as hemodialysis (HD) or HDF. The number of patients who underwent HD at home at the end of 2013 was 461, a marked increase from that at the end of 2012 (393).

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Since 2009, the peritoneal dialysis (PD) registry has been carried out as part of the annual nationwide survey conducted by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy with the cooperation of the Japanese Society for Peritoneal Dialysis. In this study, the current status of PD patients is reported on the basis of the results of the survey conducted at the end of 2013. The subjects were PD patients who lived in Japan and participated in the 2013 survey. Descriptive analysis was performed for various items including the current status of the combined use of PD and another dialysis method such as hemodialysis (HD) or hemodiafiltration (HDF), the method of exchanging dialysate, the use of an automated peritoneal dialysis (APD) machine, and the incidences of peritonitis and catheter exit-site infection. From the results of the facility survey in 2013, the number of PD patients was 9,392, a decrease of 122 from that in 2012. Among the entire dialysis patient population, 3.0% were PD patients, a decrease of 0.1%. Among the studied patients, 292 had a peritoneal catheter and underwent peritoneal lavage, 174 were started on PD in 2013 but introduced to other blood purification methods in 2013, and 1,920 underwent both PD and another dialysis method such as HD or HDF. The percentage of patients who underwent PD and another dialysis method increased with the number of years on PD: <1 year, 3.5%; 1-<2 years, 8.4%; 2-<4 years, 15.3%; 4-<6 years, 27.1%; 6-<8 years, 39.3%; 8-<10 years, 47.1%; and ≥10 years, 57.5%. The percentage of PD patients for whom the dialysate was completely manually exchanged was 31.6%, whereas the percentages of PD patients who used a bag-exchange device based on ultraviolet-light irradiation and that based on thermal sterile joint systems were 52.1 and 14.9%, respectively. The mean incidence of peritonitis was 0.22 per patient per year (once per 54.5 patients per month). The mean incidence of catheter exit-site infection was 0.34 per patient per year (once per 35.3 patients per month).

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Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterized by paresthesia, dysesthesia and the irresistible urge to move the legs, especially at night. Its prevalence is much higher among dialysis patients than in the general public. RLS is known to be associated with depression and quality of life. Recently, the association between the severity of RLS and the risk of new cardiovascular events in hemodialysis patients was also reported. In this study, we examined the relationship between RLS and mortality in hemodialysis patients. A total of 67 patients receiving maintenance hemodialysis at Sangenjaya Hospital were enrolled in this study. Clinical data, including age, gender, duration of hemodialysis therapy, complication of cardiovascular disease and cause of end-stage kidney disease, were collected. The clinical follow-up data were obtained from the hospital records. The clinical endpoints were defined as death from any cause and cardiovascular death. Cox proportional hazards model for predictors of survival was examined. RLS affected 14.9% of the study population. The mean observation period was 3.2±1.0 years. During the follow-up period, 20 deaths were recorded. In univariate regression analysis, the hazard ratio (HR) of patients with RLS was 1.79 (95% CI 1.07-2.84, p=0.030) for all-cause death and 2.97 (95% CI 1.52-5.99, p=0.002) for cardiovascular death. Multivariate Cox analysis, which included creatinine, presence of diabetic nephropathy and presence of cardiovascular disease, identified RLS as an independent predictor of mortality (HR 1.72, 95% CI 1.02-2.73, p=0.044). RLS was a risk factor for mortality, especially for cardiovascular death, and acted independently of other risk factors, including creatinine, presence of diabetic nephropathy and presence of cardiovascular disease in Japanese single-unit hemodialysis patients.

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Sevelamer hydrochloride (sevelamer) reduces serum phosphate (P) levels and stops the progression of atherosclerosis. We conducted a retrospective study in hemodialysis (HD) patients to assess the efficacy and safety of 7 years of administration of sevelamer in lowering serum P levels and in preventing the progression of arteriosclerosis. This study investigated the effect of sevelamer on serum P levels, ankle brachial pressure index (ABI), brachial-ankle pulse-wave velocity (baPWV) and non-high-density-lipoprotein cholesterol (non-HDL-C) compared with those without sevelamer (sevelamer group n=22; without sevelamer group n=22). In the group without sevelamer, ABI had decreased at year 3 and baPWV had increased at year 5 compared with those in the sevelamer group. In the sevelamer group, non-HDL-C had decreased at year 1. Serum C-reactive protein (CRP) showed a negative correlation with ABI and a positive correlation with baPWV. In conclusion, sevelamer protects against the exacerbation of atherosclerosis marker, and is related to lipid metabolism and inflammation.

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For hemodialysis therapy in an 84-year-old woman with end-stage renal disease, arteriovenous shunt formation was performed in the left wrist. Because of massive postoperative bleeding with an unknown cause, she was admitted to our hospital and the arteriovenous fistula was closed. Blood platelet count, prothrombin time and activated-partial thromboplastin time were within the normal ranges at the time of hospitalization. An arteriovenous fistula was then created in the right wrist; however, massive bleeding from the surgical site occurred suddenly 1 day after surgery. We closed the arteriovenous fistula and suspected factor XIII (F13) deficiency. Her plasma F13 activity level was 17% (normal range: 70-140%), and she was diagnosed with hemorrhagic-acquired F13 deficiency. A continuous ambulatory peritoneal dialysis catheter was placed safely in the abdominal cavity along with a prophylactic infusion of factor XIII concentrate. A few weeks later, she developed pleuroperitoneal communication. Continuous ambulatory peritoneal dialysis was discontinued. Finally, in this patient, a permanent replacement catheter was inserted into the right subclavian vein along with prophylactic infusion of factor XIII concentrate. No critical problems were found, such as fatal bleeding or delay in wound healing at the insertion site. She has been receiving maintenance dialysis therapy without any significant problems.

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