An Attempt to Curb Overuse of Dialysis / 日本農村医学会雑誌

ABSTRACT

  The number of dialysis patients in Japan is increasing every year. The medical expense for dialysis patients has now surpassed well over 7 per cent of all medical costs. This has become a great burden on national finance. The D3-30 project was started in April 2006 for Toride city residents. The purpose of this project was a 30% reduction of the yearly number of new dialysis patients in three years. Toride city is located in southern Ibaraki prefecture; it had a population of 112, 152 in fiscal 2006, and 19% of the residents were over 65 years of age. The treatment procedure for chronic kidney disease (CKD) patients at the predialysis stage comprised the following four parts 1. control of blood pressure, 2. mild restiction of protein and sodium intake, 3. administration of antiproteinuric drugs (angiotensin receptor blocker, angiotensin converting enzyme inhibitor, some calcium channel blocker, etc.), and 4. multifactorial treatment.  CKD patients were recruited through introductions from hospital registered doctors and public health nurses. Some patients entered voluntarily. The number of patients that started dialysis was counted by inquiring at the dialysis center of Toride Kyodo General Hospital and eighteen neighboring dialysis centers. In 2005, before intervention, 36 patients started dialysis; subsequently, the number of patients was 30 in 2006, 33 in 2007, 22 in 2008, and 23 in 2009. The rate of decrease was 39% in 2008 and, 36% in 2009, so the aim of the project was achieved.  If this treatment becomes widespread, it will contribute greatly to the curtailment of medical expenses. However, the difficulty of the treatment may hamper its spread. For it to spread, it is necessary to add the new medical fee for guidance and management for CKD patients.