Table 3.

Characteristics of clinical practice patterns in Japanese dialysis therapy

eGFR at the start of dialysis therapy5.43±3.43 ml/min per 1.73 m2 (2)
Percentage of home dialysis2.9% (9774; 9090 on PD and 684 on HHD) (1)
Insurance coverageAlmost 100% (out-of-pocket payment of up to 20,000 JPY for the high-income patients)
Hospital affiliated or free standingHospital affiliated 52.6%; free standing 47.4% (2)
For profit/nonprofitEntirely nonprofit; the national government does not allow for-profit medical facilities in Japan
Basic cost to be reimbursed for a single hemodialysis sessionApproximately United States $200
Professionals managing patientsDoctors and government-licensed clinical engineers as well as registered nurses
Patient-nurse ratio7.8 patients per nurse (2)
Length of session, mean ± SD (min)239.3±32.9 (2)
Times of nephrologist consultationEvery session: dialysis therapy without consultation with a doctor is prohibited by the law
Types of vascular accessAVF 89.0%, AVG 7.3%, CVC (both temporary and cuffed) 1.8%, superficialized artery 1.8%, others 0.1% (1)
Blood flow rate, ml/min206.5±36.5 (lower) (1)
Kt/V1.51±0.30 (lower) (1)
Bicarbonate levels in dialysis fluid, meq/L25–30 for acetate-containing DF, 35 for acetate-free DF (lower)
ESA use, kU/wk6±5 (lower) (4)
Iron use33% (lower) (4)
Iron dose among treated, mg/wk32±21 (lower) (4)
Serum ferritin level, ng/ml145±205 (lower) (4)
Inflammation status, mg/L, median (IQR)1 (1–3) (lower) (4)
ESA responsivenessHigher (ESA dose is much smaller, whereas hemoglobin of 10.7 g/dl is almost equivalent or slightly lower [4])
PTH target, pg/ml60–240 (lower) (6,8)
Adherence of the patients to therapies (represented by the proportion of missed treatment; in the text)Higher (0.4% in Japan, whereas 24% in the United States [10])
  • The factors potentially related to the better clinical outcome of Japanese patients on dialysis are listed. PD, peritoneal dialysis; HHD, home hemodialysis; JPY, Japanese Yen; AVF, arteriovenous fistula; AVG, arteriovenous graft; CVC, cental venous catheter; DF, dialysis fluid; ESA, erythropoiesis-stimulating agent; IQR, interquartile range; PTH, parathyroid hormone.