The present situation of medical care for peritoneal dialysis in Tokyo

DOI Web Site 1 Citations 10 References
  • Higuchi Chieko
    Tokyo Women's Medical Center East, Division of Blood Purification and Nephrology
  • Funaki Takenori
    Tokyo Women's Medical Center East, Division of Blood Purification and Nephrology
  • Ishibashi Yoshitaka
    Division of Total Renal Care Medicine, The University of Tokyo Hospital
  • Okada Kazuyoshi
    Division of Nephrology and Endocrinology, Department of Medicine, Nihon University School of Medicine
  • Kubota Minoru
    Department of Medicine, Kiyukai Oji Hospital
  • Kuriyama Satoru
    Division of Nephrology, Saiseikai Central Hospital
  • Nakao Toshiyuki
    Department of Nephrology and Dialysis, Tokyo Medical University
  • Honda Masataka
    Department of Pediatrics, Tokyo Metroporitan Hachioji Children's Hospital
  • Mizuiri Sonoo
    Department of Nephrology, Toho University School of Medicine
  • Yokoyama Keitarou
    Division of Kidney and Hypertension, The Jikei University School of Medicine
  • Sanaka Tsutomu
    Tokyo Women's Medical Center East, Division of Blood Purification and Nephrology

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Other Title
  • 東京地区のＰＤ診療の現状
  • トウキョウ チク ノ PD シンリョウ ノ ゲンジョウ

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The present study investigated the current status of medical care with respect to PD and the intent of physicians to refer patients for PD therapy. Questionnaires were sent to 218 dialysis hospitals in Tokyo that offer HD or both PD and HD (PD/HD). Completed questionnaires were returned from 149 hospitals (62 PD/HD hospitals) comprising 1,012 patients on PD (216 patients on PD+HD combination therapy). Demographic data and causes of ESRD among 788 PD patients (male : 473 ; female : 315 ; mean age : 56.7y ; mean treatment period : 36.6 months) were obtained. The causes of ESRD were CGN, DM, and nephrosclerosis. The number of hospitals in which there was an increase, decrease or no change in the number of patients referred for PD was quite similar. An increase in the number of PD patients was due to adequate informed consent (IC) being provided about the selection of renal replacement therapy (RRT), use of experts in PD therapy, or the adoption of combination therapy. A decrease in the number of PD patients was due to apprehension about EPS and the absence of an expert in PD therapy. Approximately 90% of all hospitals obtained IC for HD during the preservation period of CKD. However, the rates of IC for PD and RTx were 41.1% and 45.2% in HD hospitals, respectively, and 75.8% and 64.9% in PD/HD hospitals, respectively. The reason for not applying PD therapy in 108 out of 179 answers from HD hospitals was non-medical, such as the absence of a PD system at the hospital. In most PD/HD hospitals, PD therapy was started upon hospitalization when the serum creatinine level was 8mg/dL, surgeons inserted catheters, and PD therapy was maintained by a non-surgical doctor. Only 15% of PD/HD hospitals cooperated during the introduction or maintenance of PD therapy. The nursing tasks were diverse and educational systems for staff were insufficient. These findings indicate that the medical, medical incorporation, and educational systems for staff are insufficient. This might be associated with biased IC being provided to patients undergoing RRT, resulting in a low rate of PD induction.

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