Table 3.
Characteristics of clinical practice patterns in Japanese dialysis therapy
| Factors | Values |
| eGFR at the start of dialysis therapy | 5.43±3.43 ml/min per 1.73 m2 (2) |
| Percentage of home dialysis | 2.9% (9774; 9090 on PD and 684 on HHD) (1) |
| Insurance coverage | Almost 100% (out-of-pocket payment of up to 20,000 JPY for the high-income patients) |
| Hospital affiliated or free standing | Hospital affiliated 52.6%; free standing 47.4% (2) |
| For profit/nonprofit | Entirely nonprofit; the national government does not allow for-profit medical facilities in Japan |
| Basic cost to be reimbursed for a single hemodialysis session | Approximately United States $200 |
| Professionals managing patients | Doctors and government-licensed clinical engineers as well as registered nurses |
| Patient-nurse ratio | 7.8 patients per nurse (2) |
| Length of session, mean ± SD (min) | 239.3±32.9 (2) |
| Times of nephrologist consultation | Every session: dialysis therapy without consultation with a doctor is prohibited by the law |
| Types of vascular access | AVF 89.0%, AVG 7.3%, CVC (both temporary and cuffed) 1.8%, superficialized artery 1.8%, others 0.1% (1) |
| Blood flow rate, ml/min | 206.5±36.5 (lower) (1) |
| Kt/V | 1.51±0.30 (lower) (1) |
| Bicarbonate levels in dialysis fluid, meq/L | 25–30 for acetate-containing DF, 35 for acetate-free DF (lower) |
| ESA use, kU/wk | 6±5 (lower) (4) |
| Iron use | 33% (lower) (4) |
| Iron dose among treated, mg/wk | 32±21 (lower) (4) |
| Serum ferritin level, ng/ml | 145±205 (lower) (4) |
| Inflammation status, mg/L, median (IQR) | 1 (1–3) (lower) (4) |
| ESA responsiveness | Higher (ESA dose is much smaller, whereas hemoglobin of 10.7 g/dl is almost equivalent or slightly lower [4]) |
| PTH target, pg/ml | 60–240 (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.