To study the protective function against oxygen radicals in the mesangial area, we assessed extracellular superoxide dismutase (EC-SOD) production in mesangial cells (MCs) in vitro. These cells have a major protective function against oxygen radicals in the extracelluler space. In two different kinds of culture conditions: “growth medium” with fetal cow serum, and “differentiation medium” with reduced growth factor, and four extracellular matrixes; type I collagen, type IV collagen, laminin and fibronectin, were added to the MC culture. With the difference in the culture media, differentiation medium induced EC-SOD hyper-production associated with the both of the slowing down of cell proliferation and the suppression of IL-6 and IL-8 production. With difference in the extracellular matrix, the presence of type VI collagen and laminin promoted higher production of EC-SOD than fibronectin and type I collagen. Type IV collagen and laminin associated with the physiological condition of the glomeruli promoted EC-SOD production compared with the presence of type I collagen and fibronectin dominantly located in pathological condition. Suppression of EC-SOD production in growth medium along with MC proliferation and chemokine hyper-production compared with production in differentiation medium might mimic reduction of the protective capacity against oxygen radical toxity during mesangial proliferation in the glomerular nephritis. MC proliferation with type I collagen and fibronectin might enhance oxygen radical toxity in the glomeruli, and accelerate glomerular sclerosis through the suppression of EC-SOD production.

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Due to excessive salt and water retention, hypertension often becomes refractory in patients undergoing peritoneal dialysis (PD). Management of high blood pressure (BP) appears to be of particular importance in such patients because of its substantial impact on the patients' prognosis. However, attempts to control hypertension in PD patients have not been successful in most cases. In this regard, the present study aimed to address the adequacy of current antihypertensive therapy for PD patients. A new antihypertensive strategy expected to improve the outcome was tested on the assumption that treatment with either angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) in the evening together with α1-blocker at bed time and long-acting Ca channel blocker (CCB) in the morning might ameliorate BP control associated with morning hypertension.
Enrolled in the present study were 40 patients whose BP was evaluated by both office and home measurement. Due to an emerging concern about morning hypertension, home BP measured early in the morning was used for the analysis. Each patient was categorized into the following four groups in accordance with office and home BP: well-controlled, poorly controlled, white-coat and masked (opposite to white-coat), hypertension. After the observation period, 28 patients with refractory hypertension were allocated to intensive antihypertensive therapy in which ARB or ACE-I previously prescribed in the morning or daytime was shifted to the night. In addition, α1-blocker was given at bed time. Furthermore, long-acting CCB and diuretics were shifted to the morning. The patients were then followed up for 4-6 months. The results were as follows:
1) Of the total number of 40 PD patients, systolic hypertension was noted in 50% of cases by office BP and in 80% by home BP. The former was less frequent than the latter (p=0.0047, n=40). Similarly, diastolic hypertension was noted in 20% by office BP and in 45% by home BP. The former was less frequent than the latter (p=0.0045, n=40 by McNemar's analysis). The distribution of BP control categories was well-controlled in 11%, poorly-controlled in 42%, masked hypertension in 39% and white-coat hypertension in 8% when determined by systolic BP. The distribution was well-controlled in 45%, poorly-controlled in 13%, masked hypertension in 34% and white-coat hypertension in 8% of cases when determined by diastolic BP.
2) In 28 patients subjected to the intensive therapy, the control category of systolic BP was changed from 11 to 37% in well-controlled cases, from 42 to 30% in poorly-controlled cases, from 39 to 26% in masked hypertension cases and from 8 to 7% in white-coat hypertension cases. The shift in categories in both poorly-controlled and masked hypertension cases to the better category (well-controlled), was statistically significant (p=0.001, by Wilcoxon's signed rank test). Similarly, the control category of diastolic BP was changed from 45 to 43% in well-contolled cases, from 13 to 15% in poorly-controlled cases, from 34 to 32% in masked hypertension cases and from 8 to 10% in white-coat hypertension cases. There was a tendency for the prevalence of poorly-controlled and masked hypertension to improve to the well-controlled category in response to intensive therapy (p=0.0625, by Wilcoxon's signed rank test).
3) The plasma concentration of plasminogen activator inhibitor (PAI-1)/tissue plasminogen activator (t-PA) complex (total PAI-1 complex) was significantly decreased after intensive therapy (17.3±7.8ng/ml vs. 13.5±4.6ng/ml, n=28, p<0.01 by paired t-test). In contrast, the plasma concentration of t-PA was unchanged even after intensive therapy (4.8±3.9ng/ml vs. 6.2±2.9ng/ml, n=28, ns).
These data suggest that home BP obtained in the morning is a useful measure for evaluating morning hypertension in PD patients

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Objective: In Japan, the number of elderly patients on hemodialysis has markedly increased in recent years. We conducted a survey to confirm the current status of inpatient hemodialysis patients and dialysis facilities with the aim of providing better care.
Material and Methods: The subjects were 57 dialysis patients admitted to the Jishu Hospital for three consecutive months or longer as of February 2004. The survey was conducted by obtaining informed-consent from the patients and their families. The patients were interviewed and a questionnaire was sent to their families. The survey items were as follows; 1) patient characteristics, 2) domestic status, 3) physical and mental condition and 4) awareness concerning the hospital.
Results: The survey showed that dementia is present in almost all elderly hemodialysis patients and they require some degree of assistance for the activities of daily living. In addition, 57.9% patients had already been admitted to or had visited two or more hospitals. The current status of inpatients had improved slightly. Although the period of hospitalization was longer than one year in 64.9% of respondents, it had decreased by around 13% in comparison with that in the previous survey at 1997. These results were considered to be caused by increases in inpatient dialysis facilities, aging-related deaths, and by patients switching to home care after discharge because of the higher economic burden. In the interview, some patients were satisfied with inpatient life, but about one half of the patients said they wanted home care. Key caregivers for patients are mainly middle-aged or older family members (>50 years old), indicating that caregivers are aging. On the other hand, the present study showed that hospitalization provides advantages for family life, such as improvements in peace of mind, life rhythm, leisure time and physical condition.
Conclusion: Since the aging of dialysis patients results in a decrease in physical activity and progression of dementia, long-term hospitalization has a high potential to induce bedridden patients. In addition to the requirement for more long-term facilities, efforts should be made to improve physical activities and inhibit the progression of dementia.

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