It has been reported that hemodialysis procedures reduce the serum concentration of interferon α-2b (IFN) administered to hemodialysis patients with chronic hepatitis C. In this study we examined the possible adsorption of IFN to dialysis membranes. We tested five dialysis membranes made with four different materials: TFU 10H and AM-FP-15 with regenerated cellulose membranes (RC), FB-130U_GA with a cellulose-triacetate membrane (CTA), B1-1.3H with a polymethylmethacrylate membrane (PMMA) and PAN-13DX with a polyacrylonitrile membrane (PAN). The dialysis membranes were shredded, immersed and stirred in an IFN solution containing 5% glucose, and the residual IFN titer in the solution was measured. Under these experimental conditions, the IFN titers of FB-130U_GA, AM-FP-15, PAN-13DX and B1-1.3H declined rapidly in from 5 to 10min in all membranes. At 60min they had decreased by 10.9%, 55.0%, 65.8% and 91.4%, respectively. The adsorption rate of IFN was higher in the order of B1-1.3H>PAN-13DX>AM-FP-15>FB-130U_GA, and IFN was not adsorbed to TFU 10H. The rate of adsorption of IFN to dialysis membranes in the IFN solution containing 5% glucose seemed to be influenced by the hydrophobic property and structural characteristics of the membrane.

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The relationship between the levels of breath ammonia, blood urea nitrogen (BUN), and blood ammonia was examined by using a gas detector tube (No. 3La, Gastec Co., Tokyo) in 25 hemodialysis patients, and the usefulness of this method was evaluated. The subjects consisted of 16 males and 9 females. Their mean age was 57 years, and the mean hemodialysis period was 74 months. As complications, 8 of the subjects had hepatic diseases, and another 6 had diabetes mellitus. As controls, 92 patients who did not have severe hepatic or renal diseases were examined. The breath ammonia level (mean±SD) before hemodialysis was 23.8±25.6ppm in the hemodialysis patients, which was significantly higher than the 2.7±1.7ppm level of the controls. Before hemodialysis, breath ammonia levels in patients were related to BUN levels, but not to blood ammonia levels. After hemodialysis, the breath ammonia level decreased to 8.2±9.6ppm, but it was not related to either the BUN or the blood ammonia level. In hemodialysis patients, increases in breath ammonia were related to the BUN level. Measurement of the breath ammonia level by using this simple method is useful for determining the physical condition of hemodialysis patients.

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Poor patient outcome is well known in the diabetic ESRD (end stage renal disease) population. This study was aimed to determine the effect of biocompatible membrane (polyacrilonitrile; AN69) on the patient's nutritional status. Nine randomized diabetic hemodialysis patients appeared with informed consent in our institution. They were dialyzed with cuprammonium rayon membrane for the first 6 months as a control period, and then the membrane was switched to AN69 and the patients were dialyzed for another 6 months.
Dialysis time, dialysate flow, and content of diet education remained constant throughout the study period (12 months). The data of these two periods were compared on the basis of the group mean of every 3 months (mean±SD). The results showed that the serum albumin level was increased from 3.68±0.27 to 3.91±0.22g/dl after switching the membrane while the β₂-microglobulin level was decreased from 36.0±10.5 to 29.0±8.0mg/l. In this study period, their BW, nPCR, Kt/Vurea, and HbA_1c remained constant. We concluded that this improvement in serum albumin level with constant nPCR was partly caused by biocompatibility which may lead to protein synthesis.

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The severity and prognosis of chronic hemodialysis patients with congestive heart failure (CHF) were determined by MIBG myocardial scintigraphy and echocardiography. The subjects were 32 patients (17 males, 15 females, mean age 58±16yr) who had undergone hemodialysis treatment for an average of 17yr. MIBG myocardial scintigraphy was obtained from SPECT and anterior planar images at 15min and 4hr after MIBG injection. Myocardial MIBG uptake was quantified by the heart-to-mediastinum uptake ratio on delayed planar images (H/M) and the mean myocardial MIBG washout rate at 4hr was calculated by using the Bull's eye map (MC). The mean lung MIBG washout rate at 4hr was also obtained from planar images (LC). The left ventricular end diastolic dimension (LVDd), percent fractional shortening (%FS), wall thickness (average thickness of the ventricular septum and the posterior wall) and the ratio of peak velocity of early rapid filling to peak velocity of inflow due to the atrial contraction (E/A) were measured by echocardiography. The patients were divided according to the severity of CHF: NYHA classification grade I or II (mild CHF group, n=24) vs grade III or IV (severe CHF group, n=8). The severe CHF group showed decreased H/M, LC and dilatation of LVDd (p<0.05). Twenty-two patients were clinically followed up for one and a half years. Seven had acute worsening of CHF and required admission to a hospital. The other 15 patients did not require admission. H/M and LC were decreased (p<0.05), and E/A was increased (p<0.05) in the former group. Eighteen of the 24 patients with mild CHF were followed up and classified according to the clinical course whether or not they had acute worsening of CHF. In the acute worsening group (n=4), H/M and LC were decreased, and E/A was increased compared with the non-acute worsening group (n=14) (p<0.05). Thus, H/M and LC indicate the severity and the prognosis of chronic hemodialysis patients with CHF. Dilatation of LVDd reflects the severity of CHF, but it cannot predict the clinical course, because LVDd is always reduced by the medication for CHF. Increased E/A was found in the acute worsening CHF group, but many factors influence the E/A value and increased E/A alone cannot be prognostic for the clinical course of CHF. In conclusion, MIBG scintigraphy was more useful, than echocardiography for determing the severity and prognosis of CHF in chronic hemodialysis patients.

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Complications related to the use of internal jugular catheters for hemopurification were retrospectively studied in 39 patients with acute renal faiure, chronic renal faiure and hepatic failure. Between April 1993 and March 1997, double lumen catheters (Quinto; dual lumen catheter 11.5Fr/13.5cm) were inserted into 39 patients (22 males, 17 females, mean age 61.5yr). The mean duration of catheterization was 20.4 days (range, 2-102 days) and 495 hemodialyses were performed with double lumen indwelling catheters placed in the internal jugular vein. The patients received hemodialysis from 2 to 45 times (mean 11.5). In each catheterization period disinfection with povidone-iodine gel at the puncture site and instillation of 0.5-1ml (500-1000U) of heparin into each lumen of the catheter were carried out once a day. Of the 39 patients, only 2 had complications related to catheterization; both were insufficient blood flow. Fever over 38°C, bleeding, hematoma, spontaneous dislodgement, arterial puncture and consistent severe pain or infection at the puncture site was not seen. From these results, we recommend preferential use of an internal jugular catheter for temporary vascular access because it may have fewer complications and less trouble in catheter management than a femoral or a subclavian catheter.

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The effects of three iron compounds, Fesin^® (polysaccharated iron), Blutal^® (chondroitin sulfate iron) and Ferricon^® (sideferon), for patients with iron-deficient anemia on maintenance hemodialysis were determined when they were administered intravenously with recombinant human erythropoietin. Essentially the same improvement was obtained by these agents, but the serum parathyroid hormone level was decreased about 20% (p<0.05) only by Fesin^® From this point of view Fesin^® seemed the best for treating iron-deficient renal dialysis patients having secondary hyperparathyroidism, and Blutal^® and Ferricon^® shoud be administered to the patients with hypoparathyroidism.

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The frequency of complications related to diabetic neuropathy is increasing in patients receiving regular hemodialysis.
Diabetic neuropathy is usually difficult to treat. Here we report the case of a regular hemodialysis patient in whom continuous epidural block was dramatically effective in relieving foot pain due to diabetic peripheral neuropathy.
The patient, a 55-yr-old woman, had a 15-yr history of treatment for diabetes mellitus and a 6-yr history of hemodialysis for diabetic renal failure. She reported having pain in both feet for 10 yr. She presented at hemodialysis with sensory disturbance in both feet and her serum glucose levels remained high regardless of treatment. Her pain was strongest at night. The neuropathic pain did not respond to conventional treatment. But the pain was rapidly relieved by prolonged epidural block and completely disappeared a week after treatment. Furthermore the pain has not recurred. Epidual block may be considered as a treatment for patients on hemodialysis with pain due to diabetic neuropathy which is resistant to conventional therapy.

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We report a case of pulmonary cryptococcosis occurring in a patient with end-stage renal failure undergoing chronic hemodialysis and oral corticosteroid treatments. A-74-year-old woman was admitted to our hospital with multiple nodular shadows in the lower lobe of the right lung on a chest roentgenogram. Cryptococci were isolated from bronchoalveolar lavage fluid and the serum was positive for cryptococcal antigen.
Therapy with 200mg of intravenous fluconazole every day for one week and three times per week for three months resulted in almost complete resolution of the lesions and disappearance of the cryptococcal antigen. No side effects were observed during administration of this drug.

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