Two commercially available PTH assay systems were compared in 443 maintenance hemodialysis patients (M/F=287/156) who had received dialysis for 7.2±4.7 (SD) years. Patients who had been parathyroidectomized were excluded. There was a positive correlation between predialysis serum intact PTH levels (I-PTH) and C-terminal PTH levels (C-PTH), but the correlation was relatively low, at 0.78. A significant negative correlation was observed between I-PTH and serum total calcium concentrations (r=-0.36, p<0.0001), but there was no correlation between C-PTH and calcium levels (r=-0.05, n. s.). Both PTH levels correlated positively with the duration of dialysis, and C-PTH had a higher correlation coefficient (r=0.20, p<0.0001) than I-PTH (r=0.11, p=0.025), probably because C-terminal fragments accumulate with the decrease in residual renal function during the course of dialysis. These results suggest that measurement of I-PTH is preferable to C-PTH for estimating parathyroid hormone secretion in maintenance hemodialysis patients.

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We report 2 cases suffering from paroxysmal nocturnal hemoglobinuria (PNH) with acute renal failure (ARF) who completely recovered from ARF with the aid of hemodialysis (HD).
Case 1 was diagnosed as PNH in 1986, then took prednisolone (PSL) and was in good general condition. In 1992, she suddenly developed AFR after a hemolysis attack. She was given haptoglobin, washed RBC, and 60mg of PSL p. o., and HD was performed 8 times to treat ARF. Case 2 was diagnosed as PNH in 1974, and then treated with washed RBC infusion, fluoxymesterone, and PSL. In 1991, he suffered from ARF just after a hemolysis attack, but recovered from ARF after 12 HD sessions. Renal biopsy was performed in the latter case. The histopathological findings of the specimen included almost normal glomeruli, remarkable iron deposition in renal tubular epithelial cells, and the degeneration of the renal tubules.

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In CAPD, serum albumin is useful a predictor of morbidity. Changes in serum albumin depend greatly on peritoneal permeability in stable cases. Moreover, it is inevitable not only for peritoneal permeability to rise annually but also for hypoalbuminemia to advance. In this study, stable non-diabetic cases were classified into stages based on serum albumin and the D/P of creatinine (Cr-D/P). Serum albumin was divided into 3 stages: over 4.0g/dl, 4.0-3.5g/dl and below 3.5g/dl, each of which was further divided into 2 stages, at a boundary of Cr-D/P 0.8, as Noproblem, Stable, Pre-failure and Failure groups. As the CAPD period increased, the stage advanced to Pre-failure in an average of 37±28 months and reached the Failure stage in an average of 45±21 months. The peritoneal permeability of the Failure group rose to a serum albumin 3.2±0.3g/dl, Cr-D/P 0.86±0.20, β₂-microglobulin-D/P 0.21±0.10, and the dialysate protein to 5.3±2.0g/day. Moreover, the morbidity rate of the Failure group was higher. As a result, for the cases in the Pre-failure group with a serum albumin of 4.0-3.5g/dl and Cr-D/P over 0.8, peritoneal function should be closely observed; and for those in the Failure group whose serum albumin fell below 3.5g/dl and Cr-D/P was over 0.8, even withdrawal of the CAPD therapy should be taken into account.

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Thirty-five hemodialysis patients with xerostomia were treated with S-carboxymethylcysteine (SCMC). We administered 750-1, 000mg/day of SCMC for 1 month and the concentrations of salivary components (Na, K, Cl, Ca, BUN, Cr, amylase and pH) were measured before and after hemodialysis, and 1 month after the first administration of SCMC. Eleven of 36 cases (31.4%) achieved clinical efficacy, and there was no case with severe adverse reactions. There was a significant increase (p<0.01) in salivary volume after dialysis as compared to before dialysis. In all cases, there was no significant difference in either salivary volume or salivary components before and after SCMC administration. In the clinically effective cases, however, there were significant increases in both salivary volume (p<0.01) and salivary pH (p<0.05) after SCMC administration as compared to before administration. It is concluded that SCMC administration is effective and safe in hemodialysis patients with severe xerostomia.

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We measured plasma concentrations of pyridinoline (Pyr) and deoxypyridinoline (Dpyr), markers of bone resorption, by high-performance liquid chromatography in 34 patients on maintenance hemodialysis. As controls, 13 adults with normal renal function were employed. Pyr was undetectable in 7 of the controls (the detection limit of both Pyr and Dpyr: 3pmol/ml). The highest Pyr value in the controls was 7pmol/ml. Dpyr was undetectable in all controls. In all hemodialytic patients, both Pyr and Dpyr values were several to tens times higher than those in controls. There was a very close correlation between Pyr and Dpyr (r=0.955, p<0.001) in the hemodialytic patients. When comparing the mean values of Pyr or Dpyr, by dividing the hemodialytic patients into two groups according to the C-PTH value of each patient with a cut-off value of 2.5, 5.0 or 10.0ng/ml, there were statistically significant differences between each group on certain occasions. Both Pyr and Dpyr showed close correlations with PTHs (C- and M-), osteocalcin and tartrate resistant acid phosphatase (p<0.001), known renal osteodystrophy markers. Neither Pyr nor Dpyr correlated with the duration of hemodialysis. These results indicate plasma Pyr and Dpyr are useful parameters of renal osteodystrophy.

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Diurnal variations in plasma erythropoietin concentration (P-EPO) and urinary erythropoietin excretion (U-EPO), and changes in plasma and urine EPO after administration of recombinant human erythropoietin (rHuEPO) were investigated in normal subjects. Venous blood samples were obtained from 28 healthy subjects (13 males and 15 females) at 9am. P-EPO levels and the hematocrit (Ht) were measured. Blood samples were collected every 4 hours for 24 hours and on day 2, 3, 4, 5 and 7, and urine samples were collected every 4 hours for 24 hours from 5 other males. rHuEPO, 3, 000 units, was then administered intravenously, and rHuEPO, 3, 000 units, was administered subcutaneously to 4 other males. Blood samples and urine samples were collected in the same manner. P-EPO, Ht, the reticulocyte count (Ret) Vand U-EPO were determined. P-EPO was 18.7±1.3mU/ml (M±SE) in the healthy males and 15.5±1.1mU/ml in the healthy females, with no significant difference between them. The Ht was 45.2±0.9% in the males and 38.8±0.6% in the females, and the difference was statistically significant. The diurnal levels of P-EPO peaked at 26.1mU/ml at 4 am. The changes in Ht and Ret were unremarkable. The 24-hour U-EPO level was 17.2±2.4U/day. After intravenous rHuEPO, P-EPO rose to 351.4±32.1mU/ml 4 hours later and then rapidly decreased to the initial level by 48 hours. The changes in Ht and Ret were unremarkable. U-EPO was 16.4±3.1mU/ml during the first 4 hours and slowly decreased to the normal value by the next morning. The 24-hour U-EPO level was 52.5±6.4U/day. After subcutaneous rHuEPO, P-EPO increased to 46.4±4.3mU/ml 8 hours later and returned to initial value by 4 days. The changes in Ht were unremarkable, but Ret was higher on days 5 and 7. Changes in U-EPO were unremarkable. The 24-hour U-EPO level was 16.4±1.9U/day, similar to the value in untreated subjects.

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Impairment of pancreatic exocrine function in uremia has long been discussed. The present study was performed to evaluate pancreatic exocrine function in 11 uremic patients during the initial phase of hemodialysis therapy using direct tests, and the relationship between pancreatic exocrine function and metabolic acidosis was examined.
The subjects consisted of 7 men and 4 women with a mean age of 45.5 years, none of whom had a history of pancreatitis or alcohol abuse. Pancreatic exocrine function was evaluated using the secretin test, i.e., duodenal aspirate analysis of pancreatic juice after rapid intravenous injection of 100 units of secretin. The secretory parameters analyzed to assess pancreatic exocrine function were total volume (per 60min) of duodenal juice secreted (Vol), maximal bicarbonate concentration (MBC) in any fraction of duodenal juice collected, and total amylase output (AO).
The results of the secretin test, yielded a mean Vol of 4.7±1.0ml/kg (mean±SD) and mean AO of 3, 396±2, 038SU/kg, both significantly above the normal range (p<0.05), while the mean MBC was within normal limits (97±37mEq/l). In addition, a significant positive correlation was detected between Vol and blood pH (r=0.819, p<0.05), but there was no significant correlation between metabolic acidosis and MBC or AO.
Although long-term hemodialysis patients have been described as exhibiting impaired exocrine pancreatic function, our study suggests that the uremic patients display hypersecretion of Vol and AO during the initial phase of hemodialysis therapy. Therefore, changes in pancreatic exocrine function during the course of hemodialysis should be further investigated.

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In an attempt to determine the optimal dialysate Na concentration for short-time hemodialysis (HD), body fluid status and clinical parameters were assessed at dialysate Na concentrations of 135, 140, and 145mEq/l (the 135 group, 140 group, and 145 group, respectively).
1) After a single HD session, the serum Na concentration was lower in the 135 group, unchanged in the 140 group and higher in the 145 group. Serum osmolality was decreased in all three groups. The decrease was greatest in the 135 group and smallest in the 145 group. No differences among the three groups were found in mean blood pressure, body weight or BUN. 2) Salt sensitivity (SS) and body fluid sensitivity (BFS) to blood pressure were highest in the 135 group and lowest in the 145 group. 3) Hypotensive episodes requiring saline infusion during HD were least common in the 145 group. 4) There were no differences in clinical symptoms (e.g., nausea or muscle cramps in the lower extremities) among the three groups, however, five cases of thirst were noted in the 145 group.
These findings suggest that the optimal dialysate Na concentration for short-time HD may be between 140 and 145mEq/l. We recommend 142-143mEq/l as the dialysate Na concentration for short-time HD.

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A 64-year-old man, who had been on hemodialysis since 1974, developed asymptomatic gross hematuria in December of 1992. Chronic glomerulonephritis was the cause of his renal failure and he was already anuric in 1977. The specimen obtained by cystoscopic examination revealed amyloid deposits of β₂-microglobulin. After cystoscopy, the patient developed massive hemorrhage and severe bladder irritation.
Transurethral evacuation of blood clots and bladder fulguration stopped the hemorrhage, but severe irritability persisted for 2 months. This is the first case report of bladder hemorrhage caused by hemodialysis-related amyloidosis of β₂-microglobulin. When a patient on hemodialysis develops gross hematuria, the possibility of amyloidosis should be considered.
Cystoscopic examination should be performed carefully because cases of fatal bleeding from secondary amyloidosis after examination have been reported.

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We report a 42-year-old male with polycystic kidney disease, who initially started hemodialysis in 1988, followed by CAPD as of April 1991. On the night of November 17, 1993, after a raw saury was eaten 5 hours prior to drainage of the dialysate, a live Nematoda Larva was found in the dialysate effluent despite the absence of pain or gastrointestinal symptoms. Based on a comparison of specimens, the larva was identified as a third-stage of Anisakis type I. We therefore speculate that this raw marine fish larva entered orally, penetrating in traabdominally without causing ventricular or intestinal symptoms. Anisakiasis could be increased recently with greater opportunities to eat raw marine fish. As a result, our study strongly suggests that the finding of a live Anisakis larva in CAPD patients emphasizes the need to pay careful attention to the contamination of foods.

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APLS with coagulation abnormalities due to antiphospholipid antibody detectable in the form of anti-cardiolipin is characterized by thrombosis, habitual abortion and neurological abnormalities, as well as renal disease terminating in end-stage renal failure. Here, we report a patient with APLS with a past history of multiple vascular accidents, including pulmonary infarction, cerebral thrombosis and bleeding, and thrombophlebitis, who ultimately developed terminal renal failure requiring dialysis therapy. Although he was initially treated with thrice-weekly hemodialysis, it subsequently became impossible to maintain it because of recurrent episodes of arteriovenous fistula occlusion, and he had to be switched to CAPD therapy. CAPD proved to be quite satisfactory and the patient's subsequent clinical course has been stable and complication-free for almost two years. CAPD may be a treatment modality of choice for APLS patients with end-stage renal failure.

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