Role of the newly established Renal Replacement Therapy Professional Instructor in Japan and the future direction of renal replacement therapy

AbstractApproximately 340,000 people in Japan are on chronic dialysis, and this number continues to increase. Even today, hemodialysis is the most frequently selected modality for renal replacement therapy in Japan, accounting for approximately 97% of chronic dialysis patients. This is because the facilities and insurance for hemodialysis were developed early in Japan, and the results of treatment were very good. Most cases of kidney disease are associated with diabetes or hypertension, and the average age of patients on dialysis is increasing, which means that many dialysis patients experience reduced activities of daily living (ADL) and quality of life (QOL). To address those issues, shared decision-making and advance care planning are now widely used in the process of selecting RRT. Because of the work required, including multiple processes and information sharing, medical professionals must practice team medicine in order to improve ADL and QOL for dialysis patients and renal transplant recipients as well as promote appropriate selection of RRT. Accordingly, the “Renal Replacement Therapy Professional Instructor” certification system was established to meet this need. In addition, due to the aging of dialysis patients, there are more situations where it is necessary to consider forgoing dialysis in terms of general condition and QOL. In such cases, conservative kidney management must be offered, and the “Renal Replacement Therapy Professional Instructor” is also required to participate in them. It is hoped that a comprehensive medical system centered around Renal Replacement Therapy Professional Instructors will be created to meet the increasingly diverse needs of patients with end-stage kidney disease and their families, with the aim of providing support that will enable them to lead richer lives.