The annual survey of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) was conducted for 4,521 dialysis facilities at the end of 2022, among which 4,464 facilities (98.7％) responded to the facility survey and 4,276 facilities (94.6％) responded to the patient survey. The number of chronic dialysis patients was 347,474 at the end of 2022, marked as the first episode of a decrease since the beginning of this survey. The prevalence ratio of dialysis patients was 2,781 per million population. The mean age of the prevalent dialysis patients in the patient survey was 69.87 years. Diabetic nephropathy was the most common primary disease among the prevalent dialysis patients (39.5％), followed by chronic glomerulonephritis (24.0％) and nephrosclerosis (13.4％). The number of incident dialysis patients during 2022 was 39,683；it decreased by 828 from 2021. Among incident dialysis patients, the average age was 71.42 years, and diabetic nephropathy (38.7％) was the most common cause of end-stage kidney disease (ESKD). Nephrosclerosis replaced glomerulonephritis and was the second most common cause of EKSD. As 38,464 patients died in 2022, the crude annual mortality rate was 11.0％, the highest in the JRDR history. High mortality may be related to the decline in the total number of dialysis patients. The three major causes of death were infectious disease (22.6％), which replaced heart failure in 2022, heart failure (21.0％), and malignancy (7.6％). The number of patients treated by hemodiafiltration (HDF) has been rising since 2012 to reach 191,492 by the end of 2022, which accounted for 55.1％ of all dialysis patients. The number of peritoneal dialysis (PD) patients was 10,531 in 2022, which has slightly increased since 2017. The combination or hybrid therapy with hemodialysis (HD) or HDF was given to 20.3％ of PD patients. Home HD therapy was conducted in 827 patients at the end of 2022；it increased by 79 from 2021. Comprehensive data on anemia management was first collected in 2022 since 2012. Clinical data about Coronavirus disease (COVID-19) and the history of past living kidney donation were also investigated in 2022 as 2021. A dedicated chapter regarding peritoneal dialysis was resumed；the last dedicated report was done in 2018. Results obtained on each condition provide a scheme for more clinically effective practice patterns on these conditions to be developed.