To clarify the meaning of serum soluble IL-2 receptors changes in hemodialysis (HD) and CAPD patients, we measured sIL-2 receptor (sIL-2R) by ELISA method in 27 HD, 12 CAPD and 16 normal (N) subjects. In addition, the correlation between sIL-2R and circulating immune complexes (CIC) and the complements (CH50, C3, C4, TCC), indicators of humoral and cellular immunity, were examined.
The results were as follows: Soluble IL-2R levels were significantly higher in HD and CAPD patients than in normal subjects. No significant difference was observed between HD and CAPD patients.
CIC levels in both HD group and CAPD group were higher than those of normal subjects. Soluble sIL-2 levels in HD patients were positively correlated with C1qCIC (p<0.05), and sIL-2R levels in CAPD patients were positively correlated with C1qCIC (p<0.05) and C3dCIC (p<0.02).
TCC levels in the two patient groups were significantly higher than those of group N and showed a positive correlation with CIC.
There was a negative correlation between sIL-2R levels and CH50 in HD group (p<0.02) and CAPD group (p<0.05). These findings suggested that the elevated sIL-2R levels in HD and CAPD patients may be related to CIC and the activation of the complement system due to CIC. These results also suggested that the increased levels of CIC and complement activation observed in the two patient groups, may be associated with uremic status.

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The authors treated 8 cases of CAPD-associated sclerosing encapsulating peritonitis (SEP) without a surgical approach. All patients received nasogastric tube and were treated with total parenteral nutrition (TPN). Total energy of alimentation was determined inductively based on nutritional parameters (48.0±5.06kcal/kgBw, mean±SD).
Five of eight patients were able to be discharged from hospital. Two of these five patients continued home treatment-based IVH after discharge, and three were completely removed from TPN. One patient died of aspiration pneumonia caused by intestinal obstruction, one died of arrythmia during hospitalization, and one has been treated by IVH upon hospitalization. It was concluded that proper TPN with gastric drainage was an effective treatment option for SEP, and may improve the quality-of-life of SEP patients.

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To determine whether serum transferrin receptor (sTfR) levels are an index of erythropoiesis during recombinant human erythropoietin (rHuEPO) therapy in hemodialyzed (HD) patients with anemia, we analyzed hematopoietic parameters, iron parameters and sTfR levels in 42 HD patients, consisting of 30 patients on maintenance and 12 in the introductory stage who were newly administered rHuEPO.
sTfR was determined as the sTfR-transferrin complex (TRC) using the enzyme linked immuno-solvent assay (ELISA) and the latex agglutination nephelometric immunoassay (LA). The therapeutic effect of rHuEPO was expressed as the change in the Ht from the start of treatment to 8 weeks (ΔHt).
Ht, RBC and Hb levels were significantly increased from 1 week to 8 weeks after initiation of rHuEPO treatment. TRC levels were also significantly increased at 1, 2 and 4 weeks after the start of rHuEPO treatment. Absolute changes in the TRC level (TRC before-TRC after) and rates of change (absolute change/TRC before ×100) at 1, 2, 4 weeks after the start of rHuEPO treatment showed a significantly positive correlation with ΔHt. The absolute change in the TRC level at 1 week showed the highest correlation with ΔHt (R=0.513, p<0.0005).
These results indicate that sTfR is a useful marker as an index of the therapeutic effect of rHuEPO for anemia in HD patients.

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A validation study of three different PTH measuring kits (C-PTH, HS-PTH, and AI-PTH) was conducted on patients with chronic renal insufficiency undergoing hemodialysis, and yielded the following results.
(1) Satisfactory response curves for all three types of PTH were obtained from the detection curves determined by using standard sera. Detection sensitivity was 0.3-0.4ng/ml for C-PTH, about 120pg/ml for HS-PTH, and 2pg/ml for AI-PTH. (2) The coefficients of variation for intra-assay (simultaneous reproducibility) and inter-assay (reproducibility between measurements) in the hemodialysis patients were 4.4% and 3.9% (C-PTH), 4.5% and 7.0% (HS-PTH), and 3.4% and 8.5% (AI-PTH), respectively. These data show good precision and reproducibility with these 3 PTH assays in serum from hemodialysed patients. (3) When the influence of standing time of whole blood after sampling on stability was investigated, the measuring values were as follows: for C-PTH, stable from 15min to 24hr; for HS-PTH, stable from 15min to 8hr, but with a significant drop after 24hr; and for AI-PTH, stable from 30min to 2hr with few variations, but with slightly higher values obtained after 15min, and with a significant drop after 4hr. These results suggest that serum be separated from 15min to 24hr after sampling for C-PTH, from 15min to 8hr for HS-PTH, and from 30min to 2hr for AI-PTH to obtain reliable PTH values in hemodialysed patients. (4) The coefficient of variation for weekly differences in patients managed under the same conditions was 8.1% for C-PTH, 9.7% for HS-PTH, and 20.7% for AI-PTH.

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A statistical analysis was performed on 243 cases of chronic hemodialysis patients at our hospital during the 22 years from 1971 to 1992. The average age was 54.8 years, and the male to female ratio was 1.59:1.00. The primary diseases of these patients were chronic glomerulonephritis in 35.4%, diabetic nephropathy in 23.9%, nephrosclerosis in 10.7%, polycystic kidney in 7.0% and pyelonephritis in 4.9% of patients. Diabetic nephropathy and nephrosclerosis have increased in recent years. Compared to the 1971-1982 period, the average age increased from 50.7 to 57.3 years in the 1983-1992 period, and the percentage of diabetic nephropathy rose from 11.8 to 30.4%. Hematocrit at the beginning of dialysis was decreased significantly from 24.2 to 21.5% between the first and second period, but the transfusion volume decreased from 1.7 to 1.0 unit per month. Actual 1-, 3- and 5-year survival rates for all patients were 77.5%, 62.7%, and 47.2%, respectively. The rates were significantly lower in patients with diabetic nephropathy and nephrosclerosis than in those with glomerulonephritis. The causes of death were cardiovascular disease in 40.2%, cerebral vascular disease in 14.5%, infection in 12.8% and malignant tumors in 6.8% of patients. Fourteen patients showed complications with malignant tumor during maintenance hemodialysis. Tumors of the gastrointestinal and urinary tract organs were found most frequently (8 and 5 cases, respectively).

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Marked eosinophilia induced by nafamostat mesilate (Futhan^®; FUT), a serine-protease inhibitor, was recently reported in a hemodialysis patient. However the mechanism and the pattern of allergic reaction are currently unknown.
Here we report a case of a 56-year-old man on hemodialysis who showed marked eosinophilia (13000/μl) induced by FUT. According to challenge test results, the eosinophilia did not occur in the early phases of drug usage. However, marked eosinophilia developed with repetitive use of FUT. There was a positive correlation between the incidence of drug use and the eosinophil counts (Y=1.849+0.061^X, R²=0.95, p<0.01). Furthermore, we investigated the relationship between eosinophilia and the serum levels of the cytokines interleukin-2 (IL-2) and interleukin-3 (IL-3) induced by hemodialysis. In this case, serum IL-2 and IL-3 levels were not increased, and the IL-2 response test indicated only a low degree of activity.
These results suggest FUT may cause marked eosinophilia via cytokines other than IL-2 or IL-3.

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