{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:05:54Z","timestamp":1789376754209,"version":"build-2803163510"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dialysis care has advanced markedly over the past five decades; however, the extent of improvement and whether survival trends differ based on dialysis vintage remain unclear. We examined long-term mortality trends among patients on haemodialysis in Okinawa, Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 50-year registry data (1971\u20132020) from all dialysis facilities in Okinawa. Among the 15 698 adults who had undergone maintenance dialysis, outcomes were ascertained in 96.2%. Hazard ratios (HRs) for all-cause mortality were estimated using a Cox model. Standardized mortality ratios (SMRs) were calculated using age- and sex-specific mortality rates of the general Okinawan population. Patients were stratified by dialysis vintage at risk (&amp;lt;36 vs.\u00a0\u226536 months), and Joinpoint analysis was used to identify temporal changes in SMR trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall survival improved steadily throughout the decades. Adjusted HRs for mortality declined to 0.43 (95% confidence interval, 0.38\u20130.49) in 2011\u20132020 from 1971 to 1980. However, the magnitude differed markedly with dialysis vintage. Among patients with a short vintage (&amp;lt;36 months), mortality declined to HR 0.21 in 2011\u20132020, whereas among those with a longer vintage (\u226536 months; HR 0.67), improvement was attenuated. SMRs declined substantially until 2004, plateaued, then remained elevated in 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this closed-cohort population, mortality among patients on dialysis declined markedly over five decades; survival gains were concentrated among patients with a short dialysis vintage, whereas improvements among long-vintage patients slowed in the 2000s. The persistent elevation of SMRs despite earlier improvements highlights the need for strategies targeting patients with prolonged dialysis exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfag284","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T11:41:07Z","timestamp":1787398867000},"source":"Crossref","is-referenced-by-count":0,"title":["Survival in haemodialysis has improved considerably in Okinawa, Japan (1971\u20132020)"],"prefix":"10.1093","volume":"19","author":[{"given":"Takuhiro","family":"Moromizato","sequence":"first","affiliation":[{"name":"Okinawa Prefectural Nanbu Medical Centre and Children\u2019s Medical Centre , Okinawa ,","place":["Japan"]},{"name":"Okinawa-Asia Clinical Investigation Synergy , Okinawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoto","family":"Sakaniwa","sequence":"additional","affiliation":[{"name":"Okinawa Prefectural Nanbu Medical Centre and Children\u2019s Medical Centre , Okinawa ,","place":["Japan"]},{"name":"Public Health Department, Osaka University , Osaka ,","place":["Japan"]},{"name":"Okinawa-Asia Clinical Investigation Synergy , Okinawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiho","family":"Iseki","sequence":"additional","affiliation":[{"name":"Nakamura Clinic, Clinical Research Support Centre , Urasoe ,","place":["Japan"]},{"name":"Okinawa-Asia Clinical Investigation Synergy , Okinawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Higa","sequence":"additional","affiliation":[{"name":"Okinawa Dialysis Physician Association , Naha ,","place":["Japan"]},{"name":"Shuri Jokamachi Clinic , Naha ,","place":["Japan"]},{"name":"Okinawa Dialysis and Transplant Association , Ginowan ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Kohagura","sequence":"additional","affiliation":[{"name":"Okinawa Dialysis and Transplant Association , Ginowan ,","place":["Japan"]},{"name":"Dialysis Unit, Ryukyu University Hospital , Ginowan ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6624-0216","authenticated-orcid":false,"given":"Kunitoshi","family":"Iseki","sequence":"additional","affiliation":[{"name":"Nakamura Clinic, Clinical Research Support Centre , Urasoe ,","place":["Japan"]},{"name":"Okinawa Dialysis and Transplant Association , Ginowan ,","place":["Japan"]},{"name":"Okinawa-Asia Clinical Investigation Synergy , Okinawa 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