A statistical survey of dialysis patients for the year 2006 was carried out for 4,051 facilities in Japan, and responses were obtained from 3,985 (98.37%) facilities. The number of dialysis patients in Japan at the end of 2006 was 264,473, and this number was an increase of 6,708 (2.6%) compared with that at the end of 2005. The number of dialysis patients per one million population is 2,069.9. The gross mortality rate from the end of 2005 to the end of 2006 was 9.2%. The average dialysis starting age was 66.4 years; the average age of all the dialysis patients was 64.4 years. The primary diseases underlying the need for dialysis include diabetic renal disease (42.9%) and chronic glomerulonephritis (25.6%). At 2,873 facilities (82.4%) out of the 3,488 facilities that participated in the survey on the water quality conditions of dialysate, the endotoxin concentration in the dialysate was measured. One thousand one hundred ninety-seven facilities (37.1%) out of 3,228 measured the bacterial count in the dialysate. The average hemoglobin concentration in the dialysis patients at the end of 2006 was 10.23 (±1.33) gd/L, which agreed well with that (10.23 (±1.37) gd/L) obtained at the end of 2005. The initial average concentration of serum creatinine in 15,853 patients who started dialysis between the end of 2005 and the end of 2006 was 8.37 (±3.58) mg/dL. The estimated glomerular filtration rate (eGFR), which was obtained by multiplying the Japanese factor (?) with the value obtained using the modification of diet in renal disease (MDRD) formula, was 5.46 (±6.60 mL/min/1.73m²).

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Background : It is known that the incidence of tuberculosis (TB) in Japan is very high compared to that in Western developed countries, especially among dialysis patients. The high rate of extrapulmonary TB in dialysis patients makes it more difficult to diagnose TB. Recently a new diagnostic technique called QuantiFERON^®TB-2G(QFT) was developed and has become available for the general population. This new test is not affected by BCG vaccination status. However, the usefulness of this test in dialysis patients has not yet been examined. Method : We used this technique in thirty-three dialysis patients including 5 active TB patients, 24 non-TB patients and 4 old TB patients. Results : Six patients were positive. Five of the six had active TB and one was an old TB patient. Thirteen patients were negative. Thirteen of fourteen were non-TB patients and one was an old TB patient. We had five middle range patients including three non-TB patients and two old TB patients. Eight patients were indeterminate and none of these eight had either old or active TB. In nine patients, we had difficulty determining the causes of fever or unilateral pleural effusion, five of the nine were QFT-positive and later diagnosed as having extrapulmonary TB. The other four were QFT negative, one had Infectious Endocarditis, one had SLE pleuritis, one had infectious aortic aneurysm and the etiology in the other case was unknown. Conclusion : The findings of this study suggest that QFT is useful for the diagnosis of extrapulmonary TB in dialysis patients.

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New blood tubing is characterized by a line bypassing the blood pump segment. During the rinsing-back procedure using this blood tubing, once the initial steps, which take 25∼30 seconds, have been completed, the dialysis center staff can attend to other patients, emergency situations etc., while rinsing-back of the blood tubing is ongoing. Moreover, in the case of an earthquake or blackout, use of the new rinsing-back approach, which abandons 16∼36mL of blood in the blood tubing on the arterial needle side of the rinse-fluid-line connection and blood pump segment, one dialysis staff member can complete the rinsing-back of blood tubings for 30 patients within 3∼4 min.

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We encountered a hemodialysis patient with difficulty in maintenance of independent daily life due to higher brain dysfunction following hyperkalemic cardiac arrest. Since the actions and behavior of the patient seemed normal, we did not initially recognize the highly advanced brain functional disorder in this patient. However, his concentration lapses and abnormal actions were remarkable. After diagnosing his brain disorder, we provided medical care and welfare support in cooperation with MSW (Medical Social Worker) staff. At present, continues to receive he support from the welfare staff. However, daily independent life has been enabled and he continues attending our hospital for treatment.

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We report a case of osteoblastic metastases arising from gastric cancer after a more than ten-year disease-free interval in a hemodialysis patient. These metastases were difficult to diagnose. The patient was a 60-year-old man on maintenance dialysis since 1992. In 1993, he had undergone total gastrectomy for early gastric cancer. Elevated serum alkaline phosphatase level was initially noted in 2003. In 2004, bone biopsy was performed and histological studies showed a significant osteosclerotic lesion and metastatic adenocarcinoma. There were no other tumors on endoscopic, X-ray, CT or MRI examinations. In September 2005, he was admitted to our hospital with constipation and abdominal pain. Colorectal endoscopy demonstrated the presence of metastatic cancer of the rectum. Due to multiple metastases and peritoneal dissemination, the disease proved to be incurable and the patient received palliative therapy. He died 2 month later. Autopsy demonstrated that metastases of poorly differentiated adenocarcinoma, which resembled the histology of the previous gastric cancer, were widely distributed in various organs, including the bones. Eventually, we diagnosed metastasis from gastric carcinoma with atypical clinical progression after a more than ten-year disease-free interval. When hemodialysis patients develop osteosclerotic type bone changes, bone metastases should be considered as a part of the differential diagnosis along with renal osteodystrophy.

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