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Changes in practice patterns in Japan from before to after JSDT 2013 guidelines on hemodialysis prescriptions: results from the JDOPPS.
Tomo, Tadashi; Larkina, Maria; Shintani, Ayumi; Ogawa, Tomonari; Robinson, Bruce M; Bieber, Brian; Henn, Lisa; Pisoni, Ronald L.
Afiliación
  • Tomo T; Clinical Engineering Research Center, Oita University, 5593 Idai-gaoka,1-1, Hasama-machi, Yufu-City, Oita, Japan. tomo@oita-u.ac.jp.
  • Larkina M; Arbor Research Collaborative for Health, Ann Arbor, USA.
  • Shintani A; Currently at Michigan Medicine, Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, Michigan, USA.
  • Ogawa T; Department of Medical Statistics, Graduate School of Medicine Osaka City University, Osaka, Japan.
  • Robinson BM; Department of Nephrology and Blood Purification Center Saitama Medical Center, Medical University, Saitama, Japan.
  • Bieber B; Arbor Research Collaborative for Health, Ann Arbor, USA.
  • Henn L; Arbor Research Collaborative for Health, Ann Arbor, USA.
  • Pisoni RL; Arbor Research Collaborative for Health, Ann Arbor, USA.
BMC Nephrol ; 22(1): 339, 2021 10 14.
Article en En | MEDLINE | ID: mdl-34649519
ABSTRACT

BACKGROUND:

The Japanese Society for Dialysis Therapy (JSDT) published in 2013 inaugural hemodialysis (HD) guidelines. Specific targets include 1.4 for single-pool Kt/V (spKt/V) with a minimum dose of 1.2, minimum dialysis session length of 4 hours, minimum blood flow rate (BFR) of 200 mL/min, fluid removal rate no more than 15 mL/kg/hr, and hemodiafiltration (HDF) therapy for certain identified symptoms. We evaluated the effect of these guidelines on actual practice in the years spanning 2005 - 2018.

METHODS:

Analyses were carried out to describe trends in the above HD prescription practices from December 2005 to April 2013 (before guideline publication) to August 2018 based on prevalent patient cross-sections from approximately 60 randomly selected HD facilities participating in the Japan Dialysis Outcomes and Practice Patterns Study.

RESULTS:

From April 2006 to August 2017 continual rises occurred in mean spKt/V (from 1.35 to 1.49), and percent of patients having spKt/V>1.2 (71% to 85%). Mean BFR increased with time from 198.3 mL/min (April 2006) to 218.4 mL/min (August 2017) , along with percent of patients with BFR >200 ml/min (65% to 85%). HDF use increased slightly from 6% (April 2006 and August 2009) to 8% by April 2013, but increased greatly thereafter to 23% by August 2017. In contrast, mean HD treatment time showed little change from 2006-2017, whereas mean UFR declined from 11.3 in 2006 to 8.4 mL/Kg/hour in 2017.

CONCLUSIONS:

From 2006 - 2018 Japanese HD patients experienced marked improvement in reaching the spKt/V target specified by the 2013 JSDT guidelines. This may have been due to moderate increase in mean BFR even though mean HD session length did not change much. In addition, HDF use increased dramatically in this time period. Other HD delivery changes during this time, such as increased use of super high flux dialyzers, also merit study. While we cannot definitively conclude a causal relationship between the publication of the guidelines and the subsequent practice changes in Japan, those changes moved practice closer to the recommendations of the guidelines.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Pautas de la Práctica en Medicina / Diálisis Renal / Guías de Práctica Clínica como Asunto / Prescripciones Tipo de estudio: Guideline / Prognostic_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: BMC Nephrol Asunto de la revista: NEFROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Japón

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Pautas de la Práctica en Medicina / Diálisis Renal / Guías de Práctica Clínica como Asunto / Prescripciones Tipo de estudio: Guideline / Prognostic_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: BMC Nephrol Asunto de la revista: NEFROLOGIA Año: 2021 Tipo del documento: Article País de afiliación: Japón