| [ Summary ] |
Recently the number of standard dialyzers in use has been decreasing. High performance membrane dialyzers are thought to be used in over 80% of all cases in Japan. Hemodiafilters, which are highly permeable, have frequently been used as hemodialyzers. When highly-permeable filters are used as hemodiafilters or hemodialyzers, a pure dialysate must be used, since endotoxin is easily transported into the blood across highly permeable membranes from the dialysate. The Sicentific Committee of Japanese Society for Dialysis Therapy classified hemodialyzers into the categories of hemodiafilters and hemofilters, each having functional properties and specified standard levels of endotoxin content in the dialysate, for each type of treatment. The Japanese Ministry of Health and Welfare, on the other hand, intends to make an inclusive charge for dialyzers as well as the dialysate, blood lines, heparin, etc. In order to hold down total dialysis costs. The quality of dialysis treatment in Japan will be reduced if these inclusive charges are authorized. In the United States, where inclusive charges for dialysis exist, a dialyzer is reused 25-30 times, and the one year mortality rate is as high as 24%. Also 60% of dialysis patients were hospitalized at least once a year, according to the USRDS for 1998. The total dialysis cost in the United States including hospitalized fee and doctor's fee, was not low, although the inclusive charges for dialysis were indeed low. In Japan, dialysis treatment at a low cost should be realized by eliminating dialysis-related complications by using hemodialysis and hemodiafiltration with ultrapure dialysate and highly permeable filters. |