FP638CHANGES IN PRACTICE PATTERNS IN JAPAN FROM BEFORE TO AFTER JSDT 2013 GUIDELINES ON HEMODIALYSIS PRESCRIPTIONS

Abstract

Introduction and Aims: In May, 2013, the first guidelines for hemodialysis (HD) prescriptions in Japan were published, recommending a single‐pool KT/V (spKt/V) target of 1.4, minimum adequate dose of spKt/V > 1.2, a minimum dialysis treatment time of 4 hours, a minimum blood flow rate (BFR) of 200 mL/min, and a maximum fluid removal rate of 15 mL/kg/hr. The guidelines also noted hemodiafiltration (HDF) as enhancing the removal of small proteins (e.g., B2M) and reducing the production of inflammatory cytokines, and recommended HDF to be considered a therapy for addressing nonspecific symptoms including itching, joint pain, malaise, and poor appetite. Here we report trends from 2009‐2017 in these aspects of dialysis therapy in Japan to understand the impact of these guidelines on Japanese HD prescription practices. Methods: Analyses were carried out to describe the trends in spKt/V, BFR, duration of dialysis, ultrafiltration rate (UFR), and HDF use from August 2009 to April 2013 (just before guidelines) to April 2017 based on prevalent cross‐sections of patients from approximately 60 randomly selected HD facilities participating in the Japan Dialysis Outcomes and Practice Patterns Study (J‐DOPPS). Results: As shown in the figure and table, from August 2009 to April 2017 continual rises occurred in mean spKt/V (from 1.40 to 1.51), % patients having a spKt/V> 1.2 (78% to 88%), and % patients with BFR >200 ml/min (70% to 85%). Moreover, HDF use increased slightly from 6% in 2009 to 8% in 2013, but rose sharply thereafter to 23% HDF use by April 2017. In contrast, there was little change in mean HD session treatment time over this time period, while mean UFR declined from 7.33 in 2009 to 6.85 mL/Kg/hour in 2017. Conclusions: Substantial improvements have occurred in achieving recommended spKt/V among Japanese HD patients from 2009‐2017. This may have been achieved in part through moderate rises in mean BFR over this time with little change in mean HD session length. Furthermore, HDF use rose sharply from 2013‐2017. Other changes in HD delivery during this time, such as the greater use of super high flux dia‐lyzers, also merit study. Though causal attribution is not certain, these changes are reflective of recommendations in the 2013 Japanese guidelines for improving dialysis delivery. [Table Presented] [Figure Presented].