A nationwide survey of 4,367 dialysis facilities was conducted at the end of 2014, among which 4,330 (99.2%) responded. The number of new dialysis patients was 38,327 in 2014. 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 2014 was 30,707. The dialysis patient population has been increasing yearly in Japan ; it was 320,448 at the end of 2014. The number of dialysis patients per million at the end of 2014 was 2,517. The crude death rate of dialysis patients in 2014 was 9.6%. The mean age of new dialysis patients was 69.04 years and the mean age of the entire dialysis patient population was 67.54 years. The most common primary cause of renal failure among new dialysis patients was diabetic nephropathy (43.5%). The actual number of new dialysis patients with diabetic nephropathy has remained nearly unchanged for the last few years. Diabetic nephropathy was also the most common causal primary disease among the entire dialysis patient population (38.1%), followed by chronic glomerulonephritis (31.3%). 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 2014 was 43,283, a marked increase from that in 2012. This number is approximately twice the number at the end of 2012. In particular, the number of patients who underwent online HDF increased more than 2.5 times over the last three years. The facility survey showed that 9,255 patients underwent peritoneal dialysis (PD) in 2014. Among them, 1,913 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 2014 was 529, a continued increase from that at the end of 2013 (461).

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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 2014. The subjects were PD patients who lived in Japan and participated in the 2014 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 2014, the number of PD patients was 9,255, a decrease of 137 from that in 2013. Among the entire dialysis patient population, 2.9% were PD patients, a decrease of 0.1%. Among the studied patients, 278 had a peritoneal catheter and underwent peritoneal lavage, 193 were started on PD in 2014 but introduced to other blood purification methods in 2014, and 1,913 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, 3.3% ; 1-<2 years, 10.1% ; 2-<4 years, 16.3% ; 4-<6 years, 26.9% ; 6-<8 years, 40.9% ; 8-<10 years, 53.5% ; and≥10 years, 58.7%. The percentage of PD patients for whom the dialysate was completely manually exchanged was 32.2%, 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 52.6 and 13.7%, respectively. The mean incidence of peritonitis was 0.21 per patient per year (once per 57.1 patients per month). The mean incidence of catheter exit-site infection was 0.40 per patient per year (once per 30.0 patients per month).

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In the field of hemodialysis (HD), purification and management methods have been investigated to improve prognosis and quality of life (QOL). Considering increase in dialysis dose based on internal filtration, we provide high flux treatment with a blood flow rate of at least 350 mL/min at our clinic. The impact of high-flux HD with as few daily restrictions as possible on vital prognosis, including QOL, was compared between our data and the Japanese Society for Dialysis Therapy and other research data. The efficiency of dialysis, dialysis dose, nutrition index, and QOL of high-flux HD tended to be high, and the crude death rate was sufficiently low at 5.2%, whereas the rate was high at 21.9% in long-term dialysis patients with more than a 20-year history of HD. If internal filtration increases with high blood flow, high dialysis dose can eliminate a great number of poor prognosis factors, and good nutritional status not requiring dietary restrictions can be maintained through high dialysis dose, contributing to the improvement of QOL. High-flux hemodialysis is an important basic condition to improve vital prognosis and QOL.

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【Objectives】We investigated significant factors for long-term survival of dialysis patients. 【Subjects】Twenty-five patients (14 males and 11 females) on chronic dialysis for≥21 years (Group L) and 83 patients (58 males and 25 females) on dialysis for periods less than 20 years (Group S) at our hospital were enrolled. 【Methods】We compared nutritional indexes between Group L and Group S. We also assessed the dietary intake of Group L by using the Food Frequency Questionnaire Based on Food Groups. Furthermore, we investigated changes in the nutritional indexes over the past 20 years in Group L. 【Results】Serum albumin (Alb), creatinine generation rate (%CGR), body fat, muscle mass, blood urea nitrogen (BUN), normal protein catabolic rate (nPCR), serum inorganic phosphate (iP), and serum kalium (K) did not differ between Group L and Group S. The body mass index (BMI) of Group L was 20.1 [17.7-21.7] kg/m² and 40% of patients in Group L were lean (BMI<18.5 kg/m²). BMI of Group L remained unchanged for over 20 years, although muscle mass decreased slightly. Dietary intake of Group L largely conformed to the 2014 dietary recommendations for chronic kidney disease. 【Conclusion】To achieve long-term survival, it is important for hemodialysis patients to maintain a constant BMI and good nutritional status.

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The patient was a 59-year-old woman on maintenance hemodialysis for unknown chronic renal failure from 2010. She recognized worsening skin itching from the beginning of 2014, and extensive exudative erythema appeared on the trunk and limbs and blisters on the palm and inside of the thigh in May. Therefore, she was to be admitted to our hospital at the beginning of June, but just before that, a fistula occluded. Thus, she was treated at another hospital and then transferred to our hospital. She started treatment with oral prednisolone (PSL) with a diagnosis of bullous pemphigoid from a skin biopsy and a high level of anti-BP180 antibodies. At first, she continued hemodialysis using a catheter, but it was removed because of catheter infection. With the improvement of her skin condition, she continued hemodialysis using a fistula from the fifth hemodialysis after being transferred. The patient was discharged at the end of June. There have been few reports of bullous pemphigoid in maintenance hemodialysis patients, so we report this case along with a review of relevant literature.

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A 79-year-old anuric female with diabetic nephropathy, who had undergone maintenance hemodialysis, had a bilateral lower extremity amputation in consequence of severe diabetic neuropathy. She complained of gross hematuria from day 18 after the operation, and then abdominal pain and hypotension developed 2 days later. CT scan showed bladder hypertrophy and gaseous shadow in the lumen. These findings were consistent with a diagnosis of emphysematous cystitis. The urine culture yielded Escherichia coli, and the blood culture contained Bacteroides fragilis. Consequently, we diagnosed the patient with sepsis from emphysematous cystitis caused by these two bacteria. Ureteral catheterization and administration of an antibiotic resulted in marked improvement in the clinical course. There have been few reported cases of dialysis patients with emphysematous cystitis, especially with anuria. It is not known at present why emphysematous cystitis is so rare in dialysis patients. It is possible that it is treated as an infection of unknown origin and improved by empirical therapy. Usually, emphysematous cystitis can be successfully treated with appropriate antibiotics and bladder drainage ; however, a delayed diagnosis can result in a critical condition, such as septic shock. Making an early diagnosis of emphysematous cystitis and providing early treatment are essential to achieving a good prognosis.

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