Kidney Week

Abstract: TH-PO0713

Nationwide Trends and Resource Determinants of Continuous Hemodiafiltration in Japan: A National Database Study

Session Information

• AKI: Prevention, Diagnostics, and Management
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Fukuda, Makoto, Saga Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Saga, Saga Prefecture, Japan

Makoto Fukuda, MD, PhD

• Shibuki, Shota, Saga Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Saga, Saga Prefecture, Japan

Shota Shibuki, MD

• Hashimoto, Kohei, Saga Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Saga, Saga Prefecture, Japan

Kohei Hashimoto, MD

• Nonaka, Eriko, Saga Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Saga, Saga Prefecture, Japan

Eriko Nonaka, MD

• Yamasaki, Masatora, Saga Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Saga, Saga Prefecture, Japan

Masatora Yamasaki, MD, PhD

• Yoshihara, Maki, Saga Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Saga, Saga Prefecture, Japan

Maki Yoshihara, MD

• Miyazono, Motoaki, Saga Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Saga, Saga Prefecture, Japan

Motoaki Miyazono, MD, PhD

Background

Continuous hemodiafiltration (CHDF) is an essential modality of acute kidney replacement therapy for critically ill patients. In super-aging societies, demand for CHDF may increase, but whether regional access is uniformly maintained remains unclear. We examined decadal trends, age distribution, regional variation, and structural determinants of CHDF use in Japan using a nationwide administrative database covering the entire Japanese population.

Methods

We analyzed the Japanese National Database of Health Insurance Claims from fiscal years 2014 to 2023. Annual CHDF claims were identified using procedure codes. Trends were assessed by claim counts and crude rates per 100,000 population. Age distribution was evaluated using 10-year categories. Prefecture-level variation was quantified using age- and sex-adjusted standardized claim data ratios (SCDRs). Multivariable regression was performed with prefectural SCDR as the outcome. Covariates included ICU bed density, combined nephrologist/dialysis specialist density, population aging rate, and tertiary emergency center density.

Results

Annual CHDF claims increased from 140,826 in 2014 to 175,748 in 2023. Crude utilization rates rose from 110.8 to 141.3 per 100,000 population, with a compound annual growth rate of 2.49%. Patients aged 70-79 years constituted the largest group, and those aged >=80 years accounted for approximately 30% of all claims. Regional variation persisted after age and sex adjustment; prefectural SCDRs ranged from 0.228 to 1.806 in 2023, representing an approximately eightfold difference. ICU bed density was independently associated with higher SCDR (estimate +0.011 per 10 ICU beds per 10,000 population; P<0.001), whereas specialist density, population aging rate, and tertiary emergency center density were not.

Conclusion

CHDF utilization in Japan increased over the past decade and remained characterized by substantial use among older adults. Despite demographic adjustment, marked regional disparities persisted. ICU bed density, but not specialist density, population aging, or tertiary emergency center density, was independently associated with regional CHDF utilization. These findings suggest that ICU infrastructure may be an important supply-side determinant of access to advanced acute blood purification therapy in aging societies.