Hyogo Medical Association for Dialysis investigated the demage to hemodialysis hospitals in Hyogo prefecture by Hanshin-Awaji disaster.
Establishments were partially destroyed in 64 hospitals (62.7%) including 4 hospitals with heavy damage. As regards hemodialysis equipments, RO units were destroyed in 39.2% of hospitals investigated, supplying units for dialysate in 20.6% and bed-side dialysis consoles in 12.7%. The water supply was suspended in 50 hospitals for a mean period of 12.8±11.0 days. 43 hospitals received water wagon services. It is, however, not enough so that 15 hospitals must have kept water by their own efforts. As regards communication system, it was impossible to use telephones in 18.6% of hospitals investigated, public telephones in 11.8% and portable telephones worst in 31.4%. 36 hospitals suffered from shortage of clinical staff because some employees suffered from the disaster themselves and some lost means of land communication. 26 of those hospitals got some assistance for clinical staff, but the rest did not.
It is necessary to establish communication system and social support system to hemodialysis therapy which function even in a large-scale disaster based on this experience.

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It was found that the erucic amide and oleic amide (both amides, hereafter), used as additives for the antiblock agent in polyethylene bags of bicarbonate sodium powder, can contaminate the dialysate.
We have investigated the stages of this process of dialysate contamination and its influence on the human body. We discovered this contamination through a drop in the indicator reading of stock tank conductance with time, about three months after operating the automatic dissolving machine for bicarbonate sodium powder.
We recognized oily deposits around various parts of the stock tanks during overhauling of the automatic dissolving machine. The cause of the drop in the indicator reading was the presence of oily deposits on its electrode.
After analysis by infrared spectroscopy, we identified the oily deposits as erucic amide. Moreover, after extracting polyethylene bags and bicarbonate sodium powder with ethanol, and after analyzing the materials obtained by gas chromatography and mass spectrometry, we were able to identify the materials as a mixture of erucic amide and oleic amide. It was found that both amides, present in the bags, diffuse into the bicarbonate sodium powder during its storage and thereby contaminate the dialysate during the process of dissolving the powder. The measured amount of both amides mixed into the bicarbonate sodium powder was 0.4ppm. The erucic amide and oleic amide molecules weigh 338 and 281 daltons, respectively, raising the possibility of mixture into the blood through the dialysis membrane during dialysis treatment. No reports have been published, to date concerning the relevant safety and toxicity data on the human body.
Accordingly, the necessity of further study on the amounts of both amides mixed into blood, and their influences on the human body over long durations, are needed. Meanwhile, it is strongly suggested that the safety of other hemodialysis materials be reconsidered in light of the process of both amides mixing into bicarbonate sodium powder and then potentially diffusing into the dialysate.

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The thresholds of taste detection and recognition of saltiness were determined in 26 diabetic dialysis patients (mean age 54.3±8.4 years), by placing a test solution in the mouth for 5 seconds, and the results were compared with those of age-and sex-matched healthy controls and 58 non-diabetic dialysis patients. The daily salt and water intakes of diabetic dialysis patients were calculated, and the relationship between their intake and either taste acuity regarding saltiness and glycemic control was investigated.
The mean thresholds of taste detection and recognition in diabetic dialysis patients were 22.8±13.2mmol/l and 33.7±10.8mmol/l, respectively, values which were significantly higher than in both healthy controls and non-diabetic dialysis patients (p<0.001). No correlation between recognition of saltiness and daily intake either of salt or water was observed. Water intake correlated significantly with salt intake (p<0.001), but no correlation was found between daily water intake and either HbAlc or blood glucose levels.
These results show that diminished acuity, with regard to saltiness, in diabetic dialysis patients does not necessarily contribute to excess intake of salt and water, and that water intake is controlled mostly by salt intake rather than by blood glucose levels. In conclusion, knowing the extent of diminished taste acuity might be valuable in diet education aimed at modifying salt and water intakes.

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The effects of histamine H₂-receptor antagonists on the phosphorus binding ability of calcium carbonate were examined. Serum calcium, phosphorus, alkaline phosphatase activity (ALP), parathyroid hormone (PTH) and arterial blood pH and bicarbonate were measured during treatment with histamine H₂-receptor antagonists in 16 patients undergoing maintenance hemodialysis who were given calcium carbonate. Seven patients receiving histamine H₂-receptor antagonists without calcium carbonate were selected as controls. In the 16 patients, serum calcium levels, ALP, PTH and arterial blood pH and bicarbonate were not significantly altered during treatment with histamine H₂-receptor antagonists, but serum phosphorus levels increased significantly after four weeks (5.6±1.1mg/dl, p<0.05) and eight weeks (5.9±0.8mg/dl, p<0.005) of treatment, as compared to the pre- treatment levels (4.8±1.2mg/dl). In addition, serum phosphorus levels significantly decreased eight weeks after discontinuation of treatment with histamine H₂-receptor antagonists. In the seven patients serving as controls, serum calcium and phosphorus levels did not differ to a statistically significant extent before and after treatment with histamine H₂-receptor antagonists. From these results, it is suggested that histamine H₂-receptor antagonists significantly affect the phosphorus binding ability of calcium carbonate. Although the mechanism remains to be elucidated, one possible explanation may be the rise in pH of gastric juice. Careful observation of changes in the surum phosphorus level is warranted in hemodialysis patients receiving calcium carbonate and histamine H₂-receptor antagonists.

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We constructed an anatomical snuff box type or an anterior arm type (namely, Brescia Cimino type) arteriovenous fistulae in two groups of 10 patients with chronic renal failure, respectively, and compared these two types in terms of pre and post arteriovenous anastomosis blood flows using an ultrasound duplex system composed of a doppler flowmeter and B-mode colour scanner. 1. The mean major diameter of the radial artery was significantly smaller in the anatomical snuff box type than in the anterior arm type. However, the mean major diameter of the cephalic vein immediately after arteriovenous anastomosis was not significantly different between the two types. 2. The mean blood flow volume of the radial artery was lower, and that of the ulnar artery was higher in the anatomical snuff box type than in the anterior arm type. There were no differences between the two types in the mean blood flow volumes of the brachial artery and cephalic vein. 3. The increasing volumes of the ulnar artery, from the pre-operative value, and the ratio of this volume to the sum of the increasing blood flow volumes of radial and ulnar artery, from pre-operative values, were higher in the anatomical snuff box type than in the anterior arm type.
It was concluded that the blood flow from the radial artery to the shunt was lower in the anatomical snuff box type than in the anterior arm type, but that the blood flow from the ulnar artery to the shunt was higher in the former than in the latter. Thus, there was no difference in the shunt flow volume between these two types of arteriovenous fistulae.

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The potassium contents of all Tsumura Kampo preparations (Extract Granules for Ethical Use) were determined and evaluated. It was confirmed that the preparations contained potassium at levels ranging from 4.7mg to 50.2mg per pouch (1.88mg to 16.52mg per gram).
Among 128 preparations, 10 yielded the lowest potassium contents, less than 10mg per pouch, 43 contained 10mg to less than 20mg and 49 contained 20mg to less than 30mg, while the 92 containing 10mg to 30mg of potassium accounted for 71 per cent of total numbers of Kampo preparations evaluated. There were 17 preparations containing 30mg to less than 35mg and six containing 35mg to less than 40mg.
Three preparations, “Dai-bofu-to”, “Seijo-bofu-to”, “Keigai-rengyou-to” had the highest potassium contents, in the range of 40mg or more per pouch. When the preparations containing less than 10mg of potassium per pouch are given to patients three times a day, total potassium intake will be 30mg at most and this amount is relatively in significant compared to the potassium contents in a cup of boiled rice which contains 39mg of potassium.
Preparations containing 10mg to less than 30mg of potassium, which are not particularly high values, may produce an excessive potassium burden for some patients. Care should be taken in determining the dose of medicine, by referring to the plasma potassium level of the patient, because of overlapping intake of potassium from medicine and foods. Careful instruction must be provided for the use of the 26 preparations containing 30mg or more of potassium per pouch.
It was also shown that there is a positive correlation between potassium contents and the amount of dried extract of the crude drugs.

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A case of ileal infarction and perforation in a 73-year-old man on continuous ambulatory peritoneal dialysis (CAPD) is reported. He was hospitalized due to the appearance of cloudy CAPD fluid and subcutaneous tunnel infection, without abdominal pain or fever, from April 5th-29th, 1993. The fluid culture was negative. Four days after discharge, he was rehospitalized for severe abdominal pain, hypotension, and weight loss (from 52.0kg to 45.0kg). Again the CAPD fluid was cloudy, although the culture was negative. He was treated for peritonitis with antibiotics. On the 8th day of rehospitalization, bowel contents were found in the drainage of CAPD fluid. Laparotomy revealed 10cm of ileal necrosis ending 4cm from the ileocecal valve. Ileoectomy and ileocecostomy were performed, and hemodialysis was started via a double lumen catheter. Despite aggressive therapy, the patient deteriorated and expired on the 14th postoperative day. Dialysis-induced hypovolemia and hypotension may have contributed to ischemic ileal perforation in this case.

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A case of spontaneous splenic rupture in a patient on HD is reported. A 49-year-old man with chronic glomerulonephritis started HD in August, 1991. In September, 1993, he complained of intermittent left upper abdominal pain. However, no abnormalities were found on abdominal ultrasonography, gastrointestinal endoscopy or electrocardiography. On November 17, he developed severe abdominal pain during a routine evening HD session. The next morning, he went into shock and was emergently admitted to our center. Blood pressure was 68/-mmHg and hematocrit decreased from 26.1% to 19.6% in one day. Emergent body CT revealed a hematoma in the spleen and massive bloody ascites around the spleen. Soon after the diagnosis of splenic rupture had been made, splenectomy was performed. Bloody ascites fluid (2, 000ml) and a markedly protruding hematoma, from the enlarged spleen, were noted. The postoperative course was uneventful and he is presently on maintenance HD, as before. On pathological examination, there were no findings of infection, hematologic abnormalities, vascular disease or neoplasm. Only the hematoma and secondary infarction of the spleen were present. Spontaneous splenic rupture is very rare, but some cases receiving anticoagulant or thrombolytic therapy have been reported. Although there is only one report of spontaneous splenic rupture in a patient on HD, splenic rupture should be considered in the differential diagnosis of an acute abdomen in the HD patient.

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