The absolute risk of microhematuria was low but was a statistically significant predictor of ESKD . Notably, microhematuria is a risk factor for developing proteinuria; if combined with proteinuria, the risk of developing ESKD
is even higher compared to having proteinuria alone . The Japanese Society GDC 973 for PI3K inhibitor dialysis Therapy (JSDT) The JSDT has been conducting a nationwide survey on chronic dialysis therapy and reporting annually as ‘an overview of regular dialysis treatment in Japan’. According to the 2011 report, the total number of dialysis patients was 304,592 (2,383 pmp), and the leading cause of ESKD was diabetes (44.2 %) (Fig. 3) . The mean age has increased steadily and was 67.8 years in incident and 66.5 years in prevalent patients (Fig. 4). This result is most likely explained by the delay in CKD progression and better survival among the Japanese. The number of patients with
chronic glomerulonephritis has Selleck CHIR99021 decreased linearly since 1998, and the mean age at the start of dialysis has increased from 60.5 years in 1997 to 67.5 years in 2011. Fig. 3 Causes of primary kidney disease among hemodialysis patients in Japan (cited from ref. ) Fig. 4 Mean age of chronic dialysis patients in Japan (cited from ref. ) Since 1983, the outcomes of dialysis patients have been investigated. As shown in the OKIDS data, hypoalbuminemia is a significant predictor of death regardless of the pre-dialysis blood pressure and use of anti-hypertensive drugs (Fig. 5) . Survival among Japanese dialysis patients is better than patients in Europe and the United States, yet the reasons for this difference remain to be determined. The demographics and practice patterns differ in several ways. Patient compliance
among Japanese patients to a dialysis regimen is good. The most common vascular access is an arteriovenous fistula. A relatively small body size, with a mean BMI of approximately HSP90 21 kg/m2, might be advantageous for receiving adequate dialysis. Renal transplantation is performed in approximately 1,000–1,200 patients, and cadaveric donation is stable at approximately 200 annually. Fig. 5 Annual mortality rate of dialysis patients based on pre-hemodialysis blood pressure and serum albumin (cited from ref. ) The early initiation of dialysis has been practiced worldwide, and the mean initial estimated glomerular filtration rate (eGFR) is becoming higher than ever before [45–47]. The eGFR threshold for starting dialysis is not available. According to the JSDT, the survival was best at around eGFR 4–6 ml/min/1.73 m2 [48, 49]. The effect of confounding variables other than age and diabetes is unknown, and we need more data to determine the eGFR threshold. Most Japanese nephrologists rely on the research group criteria supported by the Ministry of Health, Welfare, and Labor, which use eGFR and the presence of uremic symptoms. The threshold for manifesting ‘uremic symptoms’ is variable between patients.