In 1994, the Japanese Society for Dialysis Therapy conducted a statistical survey of 2, 759 facilities in Japan and received replies from 2, 752 facilities (99.75%). As of the end of 1994, there were 143, 709 chronic dialysis patients in Japan, an increase of 9, 411 patients (7.0%) over a year from the end of 1993. The gross mortality rate was 9.5%, which was the second highest mortality rate since 1983. Logistic regression analysis of an overview of regular dialysis treatment in Japan revealed the factors affecting the one-year survival rate: Kt/V in excess of 1.6; over 5 hours per dialysis session (i.e., more than 15 hours' diaiysis time/week); protein catabolic rate (PCR) in excess of 0.99/kg/day in non-diabetes patients and in excess of 0.7g/kg/day in diabetes patients; less than 6% post dialysis weight loss; 4.0g/dl or more predialysis serum albumin concentration; and a predialysis phosphorus concentration of 4.0-5.0mg/dl. Moreover, the mortality rate is reportedly lower as the percent creatinine generation rate is higher. The same results were obtained from investigation of the factors influencing the frequency of hospitalization.

View full abstract

The efficacy of Lidocaine-containing local analgesic patch (tape-typed), Penles^® and the optimum conditions for use were investigated in 17 patients receiving chronic hemodialytic treatment (14 males and 3 females). The degree of pain at the puncture of blood access was evaluated using the visual analogue scale (VAS). The degree of pain was compared among the subject groups to whom a patch was applied for 30, 60 and 90 min before puncture (group 30, group 60 and group 90). A control group received the puncture without the application of a patch. The mean VAS scores (mean±S. E.) of group 30, group 60 and group 90 were 4.57±0.72, 3.00±0.51 and 2.69±0.48, respectively, and was 9.82±1.24 for the control group. There were significant differences between group 30 and the control, and group 60 and group 90 (p<0.001). In addition, the difference between group 30 and group 90 was significant (p=0.015). There was no significant difference between group 30 and group 60 (p=0.051) and between group 60 and group 90 (p=0.329). These results show that the preparation Penles^® is effective in decreasing the pain due to puncture. Although the differences between the VAS levels of group 30 and group 60 were not statistically significant, the value showed a decreasing tendency (p=0.051). Thus, the optimum application time of this patch was considered to be longer than 60min. However, it is difficult to uniformly determine the optimum conditions because individual differences in the optimum application time were fairly large.
Therefore, the optimum time for the use of these patches should be chosen in each case by testing various times of application.

View full abstract

Currently, nitric oxide (NO) is the focus of a great deal of research interest, but limited data have been reported in clinical setting of hemodialysis.
NO is almost completely converted into nitrite and nitrate (NO₂^-/NO₃^-, NOx) in vivo. Therefore, we measured circulating levels of NOx in 30 patients on hemodialysis (HD patients), 20 predialytic patients with CRF (CRF patients) and 19 healthy volunteers (controls). In addition, comparative analyses using blood pressure and the severity of aortic calcification were also done in HD patients.
Plasma levels of NOx were 171.0±96.65×10^-6M in HD patients and 136.0±68.76×10^-6M in CRF patients, both of which significantly exceeded that of controis, i.e. 59.3±31.42×10^-6M. Furthermore, in HD patients, a comparative study assessing blood pressure or the severity of aortic calcification showed a definitely higher level of plasma NOx in patients with higher blood pressure or more severe aortic calcification.
Therefore, this study showed significantly increased generation of NOx, which varyied widely among patients on hemodialysis, and indicated an important role for NO in the development and progression of macroangiopathy.

View full abstract

It is known that the R-R interval of the heart rate is variable even in the stationary state and shows a fluctuation of 1/f. A detailed investigation of the spectrum of this fluctuation shows that there are two peak levels at a particular frequency. band. It has been clarified through recent clinical applications that the highfrequency (HF) component of these two peaks reflects the activity of parasympathetic nerves while the lowfrequency (LF) component reflects the activity of sympathetic nerves. Thus, separate quantification of autonomic nerves into sympathetic and parasympathetic nerves is possible and their activities can be traced over time. Using the maximum entropy method (MEM) we recently conducted a spectral analysis of heart rate variation of about a 0.2 million beats, which had been obtained by connecting the hemodialysed patient to a Holter electrocardiograph for 48 consecutive hours and stored in a floppy disk. Moreover, we also made a regression curve, using time series results of HF and LF, by the periodic regression method. Fast fourier transformation (FFT) was used to construct the curve and the circadian rhythm pattern in sympathetic and parasympathetic nerves was investigated by cycle and type variation. These studies showed that the activities of both sympathetic and parasympathetic autonomic nerves in hemodialysed patients varied according to a 48 hour cycle. Furthermore, the sympathetic nervous system was hyperactive on the day of hemodialysis while the parasympathetic nervous system was hyperactive on non-hemodialysis days. On the other hand, the cycle of variation in heart rate is represented as a sum total of all activities and a 24-hour circadian rhythm was thus presumed to be maintained.

View full abstract

Clinical findings in elderly patients in the initial stage of hemodialysis were evaluated by comparing deceased and surviving groups. It was found that 75% of renal failure was due to chronic glomerulonephritis and/or nephrosclerosis, 10% to diabetic nephropathy. We found that the deceased group had significantly reduced serum total protein (5.77±0.85 vs 6.62±0.63g/dl. p<0.05) and serum albumin (2.79±0.579/dl vs 3.67±0.53, p<0.01), and higher levels of plasma sodium (145.08±6.47mEq/l vs 137.47±6.42, p<0.05) and chloride (110.67±7.90mEq/l vs 101.67±8.57, p<0.05). Five out of six patients in the deceased group showed hypotension during hemodialysis. These findings may suggest that lower colloid oncotic pressure and hypertonic dehydration in the deceased group.
Those in the deceased group had died within 39 days after the introduction of hemodialysis. We conclude that better fluid control in the initial stage of hemodialysis may result in an improved prognosis.

View full abstract

In order to evaluate increased plasma MPO as a consequence of neutrophil degranulation during HD, we established a method of measuring plasma MPO with an enzyme-immunoassay using a monoclonal antibody. Concentrations of plasma MPO rose rapidly at 15min after the start of HD and remained high until the end of HD. Effects of anticoagulants on MPO elevation during HD were investigated. Cross over studies of 8 patients dialysed with standard heparin and low molecular weight (LMW) heparin revealed a suppressive effect of LMW heparin on MPO elevation. The levels of granulocyte elastase were unaffected by the type of anticoagulant used. Our results show that use of LMW heparin as an anticoagulant serves to avoid the excessive granulocyte activation associated with MPO elevation which may lead to HD side effects.

View full abstract

A 52-year-old woman with Guillain-Barré syndrome (GBS) experienced rapad gait deterioration complicated by severe chronic renal insufficiency. Hemodialysis was thus instituted. No immediate improvement was observed, but symptoms were subsequently ameliorated by steroid pulse therapy. The prodromal symptom was a common cold. The latent period was about 19 days, and the duration of acute illness was 6 days. Severity at the height of the symptomatic period was grade 4 according to the scoring system established by Hughes et al. The morbid period was about 300 days.
GBS is a demyelinating polyneuritis the main symptom of which is acute motor paralysis. When the disease is associated with renal insufficiency, it is difficult to differentiate from accelerated uremic neuropathy (AUN), because both conditions show cell dissociation of cerebrospinal fluid proteins, demyelination and peripheral neuropathy in which muscle weakness predominates during the rapidly progressive phase. Thus, the clinical course of GBS resembles that of AUN.

View full abstract

We report a case of malignant melanoma in a chronic hemodialysis (HD) patient. A 65-year-old woman with a 20-year history of maintenance HD therapy complained of easy-bleeding and pain at the site of an old scar, in proximity to the nail of her left little finger, in August 1994, The fingernail had been injured more than 10-years previously, and the wound had scarred over. She was diagnosed as having acral lentiginous malignant melanoma by a dermatologist. She underwent ray amputation of the left little finger and left axillar lymph nade dissection, but the melanoma cells had already invaded subcutaneous tissues. The melanoma was thus classified as level V./Stage III. Although chemotherapy was planned, we presently hesitate to commence treatment with antineoplastic agents because of her complications and poor general condition. The incidence of malignancy in HD patients is higher than that of the general population. As such, the need for chemotherapy in HD patients is expected to increase in the future, although difficulties encountered in treating these patients with antineoplastic agents persist.

View full abstract

The patient, a 66-year-old female suffering from chronic renal failure due to Sjögren syndrome, had been undergoing hemodialysis since January, 1992. In July, 1994, she developed new symptoms including swelling of both parotid glands and neck lymph nodes, fever, photophobia and an abnormally high. serum amylase value of 1, 195IU/l. Isozyme analysis of the amylase by electrophoresis showed an abnormal pattern which was difficult to classify. Further examination by Superose 12 gel permeation HPLC, immunoprecipitation reaction and counter immunoelectrophoresis revealed that this amylase was a macroamylase resulting from bonding with Ig-Aλ. This bonding accounted for the high amylase value.
This case experienced recurring gastrointestinal bleeding and, despite repeated extensive examinations, the exact cause could not be determined. Lymph node histodiagnosis during exploratory laparotomy revealed non-Hodgkin type of malignant lymphoma.
The patient died, due to the complication of disseminated intravascular coagulation postoperatively.
The average serum amylase value is higher for hemodialysis patients than for healthy subjects and pancreatitis Can raise this value even higher. However, Since there are very few reports of macroamylasemia in hemodialysis patients and no reports of Sjögren syndrome complicated by macroamylasemia, this case appears to represent a rare disorder.
We have presented a brief discussion, based on the literature, concerning the occurence of macroamylasemla in this case.

View full abstract