Learning from the Japanese Registry: how will we prevent long-term complications?

As compared to Europe and USA, the survival rate of chronic haemodialysis (HD) patients in Japan is demonstrated by the Japanese Registry to be high. However, another Japanese nationwide survey on their quality of life revealed serious osteoarticular disorders increasing with the duration of HD. Selecting plasma β 2 -microglobulin (β 2 -M) as a marker, a prospective study on the long-term clinical effect of a β 2 -M-removable membrane (PMMA BK membrane) has been performed and the changes in joint pains and plasma β 2 -M have been followed for 5 years. In addition, the incidence of carpal tunnel syndrome (CTS) and bone cysts among 225 patients maintained on HD with BK membrane was analyzed retrospectively. By continued use of BK membrane, plasma β 2 -M was maintained at a significantly lower level than that in HD with conventional cellulosic membranes. The total score of joint pain in HD patients treated with BK membrane was significantly decreased and maintained at this low value throughout 5 years. In HD patients treated with BK membrane for a long period, the occurrence of CTS and bone cyst was less and postponed, as compared to patients on HD with conventional cellulosic membranes. HD-related amyloidosis had not been observed for 5 years in patients treated with BK membrane from the introduction of haemodialysis.