In 1995, the Japanese Society for Dialysis Therapy conducted a statistical survey of 2, 871 facilities in Japan and received replies from 2, 866 facilities (99.82%). As of the end of 1995, there were 154, 413 chronic dialysis patients in Japan, an increase of 10, 704 patients (7.4%) over a year from the end of 1994. The gross mortality rate was 9.7%, which was the highest mortality rate since 1983.
The mean age of the patients who started their dialysis therapy in 1995 was 61.0 years old (±14.20 years old S. D.). This shows that the dialysis patients' aging had advanced more than last year. The patients who started dialysis due to chronic glomerulonephritis in 1995 decreased compared to last year. This is 39.4% out of all the patients who started dialysis in 1995. On the other hand, the patients who started dialysis due to diabetic nephropathy increased, and their percentage was 31.9%.
In this survey, Japanese dialysis patients'social status was also investigated. Results showed that 78.6% of all male dialysis patients and 18.8% of all female patients, whose age was between 15 and 59 years old, were full-time or part-time employees.
Logistic regression analysis of the life expectancy of regular hemodialysis patients in Japan revealed that the following factors were death risks: pre-dialysis serum β₂-microglobulin concentration in excess of 30mg/l, less than 30% pre-dialysis hematocrit, and dose of recombinant human erythropoietin in excess of 6, 000 units per week.

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From 1971 to 1993, 102 children, 1 to 15 years of age, with end-stage renal disease (ESRD) were treated in our kidney center. Hemodialysis was started in 48 patients and peritoneal dialysis in 54, among whom 6% and 39% were children under 6 years of age, respectively. Forty-four patients received renal transplantation (Tx), only three of whom received a cadaver kidney. The survival rate of the 102 children was 72% at 10 years, being 62% before 1980 and having improved to 84% after 1981. The improvement reflects the introduction of CAPD. The patient survival rate for live-related renal Tx was 88% and kidney survival was 46% at 10 years. Improvement of long-term care for children with ESRD was achieved by involving hospital staff members, as well as by advances in dialysis techniques and the use of various new drugs.

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We compared lymphatic absorption (LA) using dextran 70 and albumin in 9 children, 8 boys and 1 girl, on peritoneal dialysis. Their average age was 12 years (5-19yr). LA estimated using dextran 70 as a marker substance was 3.0ml-7.5ml/kg/4 hours (average 5.3±1.4ml/kg/4 hours). LA estimated using albumin as a marker substance was 0-29ml/kg/4 hours (average 8.8±9.9ml/kg/4 hours). There was no significant correlation between LA estimated by dextran 70 and that estimated by albumin (r=0.4). Six of 9 patients receiving the albumin solution complained of abdominal pain; however, no patients given the dextran 70 solution complained of abdominal pain. Based on these observations, dextran 70 appears to be a better marker than albumin for measuring lymphatic absorption.

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We previously reported that plasma levels of NO₂^-/NO₃^- (NOx) were distributed in a wide range, varying from normal to elevations as high as six times normal in patients on maintenance hemodialysis. Increased production, rather than intradialytic accumulation, was speculated to account for this elevation. According to our previous data, we proposed an underlying mechanism involving increased production of NO to be intimately associated with this progressive process reflecting certain complications of long term hemodialysis, such as atherosclerotic change.
The vascular system, including circulating macrophages, is primarily responsible for the generation of NO. Therefore, we measured plasma NOx levels in 29 hemodialysis patients and made comparisons with the Aortic Calcification Index (ACI) and Ankle Pressure Index (API) in order to investigate the effect of NO on atherosclerotic change in the characteristic setting of hemodialysis.
Plasma levels of NOx in hemodialysis patients varied from 42.6 to 367.6, 160.1±87.28×10^-6M on average, and significantly correlated with ACI (r=0.701, p<0.001) and API (r=-0.446, p<0.02).
Consequently, we demonstrated herein a close relationship between the plasma NOx level and the degree of calcified atherosclerotic change. However, the mechanism underlying NO production in accelerated atherosclerotic change in maintenance hemodialysis patients remains to be clarified in further studies.

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In order to evaluate a prospective bone metabolism value, several acknowledged parameters, including pyridinoline (PYR) and deoxypyridinoline (DPYR), were compared with resorptive changes seen on X-ray film over a 2 year follow-up period in 48 hemodialyzed patients who did not have elevations in serum total alkaline phosphatase (ALP) activity and no radiological resorptive signs more severe than grade 1 of Jensen's criteria. Twelve patients (25%) showed progression of resorptive change on X-ray film at the 2 year examination. Data were analyzed for two patient groups, i.e. one with progression of resorptive signs and another 36 patients (75%) without such radiographic signs. All parameters other than tartrate resistant acid phosphatase (TRACP) were significantly higher in the former patient group than in the latter, but considerable overlap was recognized between the two patient groups in total ALP, bone ALP and bone Gla-protein. In contrast, very few of such overlapping cases were seen for PYR and DPYR. Based on these results, we assume that all chemical bone markers other than TRACP are useful to some extent, but are not satisfactory as predictive indicators for resorptive bone damage. However, PYR and DPYR may prove to be reliable indicators of the potential progression of resorptive bone change in subclinical renal osteodystrophy patients.

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Hypoparathyroidism is known to be one of the causes of aplastic bone disease in patients on chronic hemodialysis (HD). However, little is known about the precise mechanism and clinical characteristics of hypoparathyroidism. We investigated the clinical characteristics of hypoparathyroidism in HD patients employing a cross-sectional and retrospective longitudinal study. Eighty HD patients were divided into 3 groups according to the levels of serum intact-PTH; low PTH group (<50pg/ml, 34 cases), medium PTH group (50-150pg/ml, 23 cases), and high PTH group (>50pg/ml, 23 cases). There were no differences in age or gender among the 3 groups. The duration of HD was shorter in the low PTH group than in the high PTH group (p<0.01). There were no differences in the doses of calcium carbonate, vitamin D therapy, serum Ca, or P among the 3 groups. Serum 1, 25-dihydroxyvitamin D in the low PTH group was not different from those of the other 2 groups. Serum aluminum in the low PTH group was lower than those of the other 2 groups (p<0.05). The bone mineral density at the distal radius measured by DXA was similarly decreased after the start of HD in all 3 groups, based on cross-sectional study. The retrospective longitudinal study of microdensitometry of thehand demonstrated progressive decreases and there were no differences among the 3 groups. The retrospective longitudinal study of c-terminal PTH demonstrated that there were no differences in c-PTH among the 3 groups until 5 years after the start of HD. These data demonstrated that hypoparathyroidism does not differ in terms of clinical characteristics, other than a briefer duration of HD and a lower serum level of aluminum, and that hypoparathyroidism in HD patients does not affect bone mineral density. Furthermore, we cannot discriminate hypoparathyroidism from potential secondary hyperparathyroidism until 5 years after the start of HD. The pathogenesis of hypoparathyroidism remains unkown, but these observations suggest that undefined factors, of which the effects manifest 5 years after the start of HD, play some role in the development of this disorder.

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Loss of ultrafiltration is one of the important complications to deny the longterm continuation of CAPD therapy. The low pH and high osmotic pressure of the dialysate are often pointed out as the causes of the ultrafiltration loss. We prepared sodium chondroitin sulfate (CHS) as a dialysate osmotic agent that was considered to have a protective effect on the peritoneum. And we investigated its usefulness in an animal model (CAPD rabbits; in vivo), and in cultured human peritoneal mesothelial cells (in vitro). We prepared glucose containing dialysates (PERITOLIQ^®: P135, P250, P400) as a control, CHS-containing dialysates of the same osmolality as these three, and a CHS 1.5%-containing dialysate of 290mOsm/L. One hundred fifty-ml quantities of one these dialysates was infused into the peritoneal cavity of a each of three CAPD rabbits, and the effluent was measured for 24 hours after the infusion. Such dialysates were infused once daily for 4 weeks and the peritoneal function was studied by performing PET once weekly. Also, to investigate the cytotoxicity of the CHS-containing dialysate, we incubated human peritoneal mesothelial cells for 6 hours in each dialysate and measured their ₅₁Cr release into the medium. As a result, the effluent volume was decreased over time in the three PERITOLIQ-dialysate groups, and at 24 hours after the infusion no effluent was obtained at all. CHS-containing dialysates, however, produced an effluent which was increased in a dose-dependent manner, and its volume was maintained satisfactorily even after 24 hours. Regarding the effluent volume measured at the weekly PET, it was impossible to measure it in the CHS250 and CHS400 groups, and there were about a 70 percent decrease in the P250 and P400 groups, about a 40 percent decrease in the P135 and CHS135 groups, but only a slight decrease (about 15 percent) in the CHS 1.5% group. The higher the osmolality of the dialysates containing PERITOLIQ or CHS, the more cytotoxic they were for cultured human mesothelial cells. Based on the observations that the effluent could be retained when the CHS-containing dialysate was used even at low osmolality and that its pH could be easily neutralized, CHS was considered to be an effective osmotic agent.

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A 60-year-old male, who had undergone maintenance hemodialysis (HD) for 6 months after ceasing continuous ambulatory peritoneal dialysis (CAPD), was admitted to Hino City Hospital because of abdominal pain, vomiting and ascites in November, 1995. He had suffered four episodes of bacterial peritonitis during a 7 year course of CAPD management. In April, 1994, CAPD was discontinued with conversion to HD because of anasarca and consciousness disturbance. On admission, he had a distended abdomen, and paracentesis showed bloody exudative ascites without malignant cells. Plain abdominal X-ray showed niveau formation, and computed tomography demonstrated a mass of thickened intestine and a large volume of ascites. Despite hyperalimentation given under a diagnosis of sclerosing peritonitis, his nutrition and general condition deteriorated and he died 3months after initiating intensive treatment.
Sclerosing peritonitis is a rare but lifethreatening complication of CAPD. It usually develops in patients undergoing CAPD, but this serious conplication should be considered even after CAPD has been discontinued.

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A 63-year-old male was admitted to the hospital because of tarry stool and progressive anemia. He had been on hemodialysis for 9 years and had liver cirrhosis. Endoscopic examination revealed diffuse gastric antral vascular ectasia with intensely reddish dots and oozing. Non-anticoagulant hemodialysis was prescribed together with transfusions and anti-ulcer agents. Although temporary hemostasis was achieved, anemia worsened after transarterial embolization therapy for hepatocellular carcinoma which had been recognized on computed tomography. Neither endoscopic clipping therapy nor heat coagulation therapy could stop the bleeding. The patient's condition was too poor to allow gastrectomy. Therefore, topical injection of polidocanol was performed endoscopically, and persistant hemostasis was achieved. Diffuse gastric antral vascular ectasia is usually refractory to conservative therapy and often requires a gastrectomy. However, as we have described herein, endoscopic screlotherapy may be effective for this disease even when conventional procedures have been unsuccessful.

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