Nephrology in Japan

In Japan, kidney diseases are detected in their early stages by various health checkup systems, and thereafter patients may swiftly be indicated to further examinations and treatments, which are fully covered by the public health insurance system. Pathophysiological approaches for primary glomerular diseases based on a kidney biopsy has been one of the mainstreams in the Japanese nephrology. There were about 340,000 chronic dialysis patients and more than 4000 dialysis facilities in Japan. Most of the patients are treated by in-center hemodialysis; home dialysis (both peritoneal dialysis and home hemodialysis) is not the major option. In in-center dialysis, online hemodiafiltration and protein-permeable dialysis have been usually performed to effectively remove middle molecular uremic toxins, which has been a unique concept of chronic dialysis in Japan. Kidney transplantation is gradually developing, but its volume is not enough, especially deceased donors grafts, which is quite low. The most recent major concern is frailty of the dialysis patients who are older and have long dialysis vintage.