The total body bone mineral density (BMD) in Japanese hemodialysis (HD) patients was compared with that of healthy subjects, in terms of BMD characteristics by sex, age and dialysis history. The subjects were 346 patients receiving HD treatment at the Narita Memorial Hospital Dialysis Center (209 males, 137 females). The controls were 1385 healthy subjects. For total-body BMD measurement, dual energy X-ray absorptiometry (DXA) was used, along with a Lunar DPX bone densitometer. BMD levels in both male and female HD patients were lower than those of normal subjects in their 30s to 50s. Males, in particular, showed a marked decrease in BMD in their 30s, 40s and 50s, while females did so in their 40s, 50s and 60s (both p<0.001). There was no significant difference, however, between either male or female HD patients and normal subjects in terms of BMD in their 70s. No significant difference was recognized in BMD levels between male HD patients with a dialysis history of less than 3 years and the normal subjects, both ranging from 50 to 70 years of age. Thus, we considered BMD to have decreased minimally during conservative therapy in male chronic renal failure patients. However, BMD levels in females in their 40s to 60s with a history of less than 3 years of HD, showed a significant decrease as compared to normal subjects (p<0.01). Using multiple regression analysis, body weight loss was found to be one of the major risk factors for BMD loss. In conclusion, BMD differences were found to exist in HD patients in terms of sex, age and dialysis history.

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Levofloxacin (LVFX) is a new antibacterial agent derived from ofloxacin (OFLX). We measured and compared the growth inhibitory rings for several bacterial strains for each drug and also studied the pharmacokinetics of LVFX in patients undergoing hemodialysis (HD). The growth inhibitory ring of LVFX was about one and half times as large as that of OFLX. We monitored the serum concentration of LVFX during HD therapy in 13 patients after oral administration of 100mg LVFX, to obtain the biological half life time (T_1/2), clearance (CL_LVFX) and sieving coefficient (SC_LVFX). The maximum LVFX concentration was 1.59μg/ml just before HD and had decreased to 0.99μg/ml by 4 hours of continuous HD therapy. CL_LVFX, SC_LVFX and T_1/2 were 113.6ml/min, 0.74 and 6.3 hours, respectively, under the condition of HD therapy and T_1/2 was 55.4 hours on a nondialyzed day. There was no significant difference in CL_LVFX between polysulfone and cellulose triacetate membranes. The HD patients received HD therapy every other day, allowing calculation of the recommended dosage of LVFX, 100mg once a day for 4 days, from the multiple-dose study.

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We examined whether plasma BNP predicted cardiovascular events in hemodialysis patients.
Plasma hANP and plasma BNP were measured in 78 cases before and after hemodialysis. All cases were classified into four groups according to plasma hANP (more or less than 100pg/ml) and plasma BNP (more or less than 300pg/ml), as measured after hemodialysis, and electrocardiographic ST-changes, the cardiothoracic ratio on chest X-ray, the left ventricular mass index on echocardiogram, and underlying diseases. We classified all cases into the following four groups, based on the two dimensional display, hANP<100 and BNP<300: preload controlled, non-myocardial injury group (group I), hANP<100 and BNP≥300: preload controlled, myocardial injury group (group II), and hANP≥100 and BNP<300: preload poorly controlled, non-myocardial injury group (group III), hANP≥100 and BNP≥300: preload poorly controlled, myocardial injury group (group IV). We evaluated group I and group II in this study, in which preload was well controlled by hemodialysis.
There was a significant difference in BNP between the positive ST-change group and the negative ST-change group (before hemodialysis: 632±337pg/ml vs 123±93 pg/ml, p<0.01. after hemodialysis: 587±301pg/ml vs 109±73pg/ml, p<0.01). The cardiothoracic ratio in group II was increased as compared to that of group I (56±8% vs 51±5%, p<0.01). The left ventricular mass index in group II was 134±33g/m² (vs 125±29g/m² in group I, NS). In terms of underlying diseases, the prevalence of diabetes mellitus in group II was 25% (vs 20% in group I, NS). The rate of positive ST-changes in group II was higher (42% vs 20%, p<0.01) than that in group I.
We considered the increase in plasma BNP after hemodialysis to have been caused by cardiac hypertrophy and/or myocardial ischemia. The cases in which plasma BNP was elevated even after plasma hANP had been decreased by hemodialysis were suggested to be a high risk group. Plasma BNP was suggested to be a predictor of cardiovascular events in hemodialysis patients.

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Gastric motility was evaluated in chronic dialysis patients, and the role of delayed gastric emptying in the occurrence of gastrointestinal symptoms and nutritional status was compared in diabetics and non-diabetics. We classified 34 diabetics (19 hemodialysis (HD) patients and 15 continuous ambulatory peritoneal dialysis (CAPD) patients) and 45 non-diabetics (23 HD patients and 22 CAPD patients) as either having delayed gastric emptying (D group) or normal gastric emptying (N group) according to the serum levels of acetoaminophen following oral administration. Diabetics included more D group patients than non-diabetics (65% vs. 36%). D group included 39% of non-diabetic (nonDM) HD patients, 58% of diadetic (DM) HD patients, 32% of nonDM-CAPD patients and 73% of DM-CAPD patients. D group non-diabetics did not complain of gastrointestinal symptoms irrespective of HD or CAPD. However, the number of patients who had symptoms was significantly greater in D group DM-CAPD patients than in DM-HD patients. There were no significant differences in nutritional variables between D group and N group among HD patients, irrespective of diabetes. In contrast, D group DM-CAPD patients showed the lowest muscle volume of all CAPD patients. It is concluded that delayed gastric emptying might be associated with the occurrence of gastrointestinal symptoms or poor nutritional status in DM-CAPD patients.

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We examined internal A-V fistula complications in 6 patients using 3D-CTA and plain angiography of internal A-V fistulae (PAG). Technical specifications of 3D-CTA were carried out with a CT scan unit (X visors GX, Toshiba, Japan) using the shade surface display method.
As to visualization of various changes occurring in vascular structures, 3D-CTA was comparable to PAG. Furthermore, 3D-CTA allowed superior visualization of arteries and veins in patients with a large shunt blood volume.
Although further improvement of software, in terms of 3 dimensional reconstruction, is needed we consider this a potentially valuable tool for examining internal A-V fistula complications.

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A 51 year old man, who had been suffering from end stage renal disease and had been on hemodialysis since 1980, was changed to CAPD in 1988. His water restriction was extremely poor and he developed hypertension and cardiomegaly. Idiopathic dilated cardiomyopathic findings were seen on ultrasonography. He was frequently admitted to our hospital and could not stay in his home because of severe cardiac dysfunction. After starting metoprolol tartrate, 1mg per day, clinical findings of cardiac failure improved, allowing discharge. Eight months later, he suddenly died at home. According to autopsy, findings of diffuse myocardial fibrosis, but not dilated cardiomyopathy, were observed. Metoprolol tartrate may be effective in dialysis patients with severe congestive heart failure.

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We report a hemodialysis (HD) patient with elevated serum erythropoietin (EPO) as a tumor marker of renal cell carcinoma (RCC).
The case was a 50-year-old male, who had been on hemodialysis for 14 years.
He was incidentally diagnosed as having a left renal tumor with acquired cystic disease of the kidneys by computed tomographic scanning. He presented an elevation of hematocrit (Ht) up to 33% with unexpected erythrocytosis despite no EPO supplementation. His serum EPO level was inappropriately high, at 57.8mU/ml.
The EPO level concomitantly increased to 122mU/ml with enlargement of the left renal tumor at 7 months. At this time, he underwent left radical nephrectomy for the renal tumor. The pathological definitive diagnosis of RCC was confirmed. Postoperatively, his EPO level decreased markedly to 15.7mU/ml.
We propose that an inappropriate EPO level is a potentially useful tumor marker of renal cell carcinoma with acquired cystic disease of the kidneys in dialysis patients.

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We report a case of sudden blood pressure drop during hemodialysis (HD) caused by mid-ventricular obstruction with hypertrophic cardiomyopathy. A 57-year-old female, who had been undergoing chronic HD therapy due to nephrosclerosis since April 1989, was admitted to our hospital because of left lower leg pain at rest. After admission, sudden drops in blood pressure were frequently observed during HD. As an angiographic study disclosed severe narrowing of the left femoral arterial lumen, she underwent aorto-femoral bypass sugery. Intraoperatively, her blood pressure dropped due to perioperative events. Thus, catecholamines were administered intravenously in order to maintain blood pressure. However, her blood pressure became much lower and discontinuation of the catecholamines reversed the blood pressure fall. Cardiac catheterization examination and dobutamine loading echocardiography revealed a left venricular obstruction at the level of the papillary muscles, the existence of a pressure gradient at the left venricular pre-out flow tract and a change in the pressure gradient during HD. Therefore, we concluded that the hypotension during HD was caused by mid-ventricular obstruction associated with hypertrophic cardiomyopathy. A β-blocking agent decreased the mid-venricular pressure gradient and obliterated the sudden blood pressure falls during HD.

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