We investigated the factors that participate in the progression of atherosclerosis in chronic hemodialysis patients. Two graphical methods, ultrasonic carotid arteriography and computed tomography, were compared concerning the evaluation of atherosclerosis in these patients. To exclude the influence of the cause of disease patients with diabetic nephropathy and hypertensive nephrosclerosis were excluded. The degree of carotid arterial sclerosis (DCS) evaluated semi-quantitatively, normal (0°) to 4°, with ultrasonic arteriography and the abdominal aortic calcification index (ACI) with computed tomography was assessed in 41 patients (21 male, 20 females; age 53±1 years, mean hemodialysis duration 14±1 years). There was a significant correlation between DCS and ACI (ρ=0.484, p<0.01). Male, age, systolic blood pressure, and the duration of hemodialysis were selected as significant factors of DCS by multiple logistic regression analysis. However, other variables such as smoking, lipid profiles and calcium-phosphorus products were insignificant. No other significant relationship was found between ACI and these clinical variables. These findings suggest that DCS evaluated with ultrasonic carotid arteriography is more useful than ACI for evaluating atherosclerosis in patients on chronic hemodialysis. Furthermore, dialysis therapy itself and/or the duration of renal failure may be risk factors for of atherosclerosis in hemodialysis patients.

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The pharmacokinetics of ciprofloxacin (CPFX) in plasma and peritoneal dialysate after single administration at a dose of 200mg were investigated in 3 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The dialysate in CAPD was changed every 6 hours. The maximal plasma concentration (C_max), the time to reach the maximal plasma concentration (T_max), the plasma elimination half-life (T_1/2) and the area under the curve (AUC) were 1.87±0.12μg/ml, 1.31±0.47 hours, 6.24±0.52 hours and 18.46±1.83μg·hr/ml, respectively. Concentrations in the peritoneal dialysate during the 1st exchange after 6 hours ranged from 0.47 to 0.69μg/ml. During the subsequent exchange until 48 hours, the plasma concentration gradually decreased. AUC and the dialysate concentration were significantly correlated (r=0.877).
Drug concentration-time profile in CAPD patients under the condition that 200mg of CPFX was given every 12 and 8 hours, was simulated using 1-compartment model, according to the plasma and peritoneal dialysate concentration profile achieved after single administration of 200mg of CPFX.
The plasma and dialysate concentrations ranged from 0.75 to 2.54μg/ml and 0.40 to 0.96μg/ml given every 12 hours, and 1.45 to 3.17μg/ml and 0.94 to 1.15μg/ml given every 8 hours, respectively.
The plasma level for 200mg of CPFX given every 12 hours and dialysate level when CPFX was given every 8 hours were greater than 0.78μg/ml. The MIC needed to inhibit about 90% of most bacterial species of peritonitis was reported.
Our findings suggested that an oral dose of 200mg of CPFX, 2 or 3 times a day, is useful for CAPD peritonitis.

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Between January 1996 and August 1997, 13 hemodialyzed patients with chronic renal failure underwent open cardiac surgery. Ten of these patients had coronary artery bypass grafting, and 3 had valve replacement. They received 3-day hemodialysis in the preoperative period, intraoperative hemodialysis connected to cardiac pulmonary bypass (CPB), and continuous hemodiafiltration in the early postoperative period (HD group). The perioperative clinical parameters of the HD group were compared to those of 22 age-matched patients with normal renal function undergoing open cardiac surgery as controls (NRF group). When the perioperative variables were compared, no significant differences were seen in total operation time, CPB time or postoperative fasting time, but we noted significant increases in the mean volume of transfused blood for 6 days before the operation, postoperative intubation time, and time spent in the intensive care unit. Levels of central venous pressure, systolic blood pressure and daily fluid balance of the HD group were the same as the control in the early postoperative period. In addition, the levels of serum creatinine, urea nitrogen, potassium, and hematocrit of the HD group were mostly constant in the early postoperative period. The hospital mortality of the HD and NRF groups was 0%. In conclusion, our intensive perioperative dialysis program may successfully manage the perioperative clinical course of hemodialyzed patients with a slightly greater risk than that of patients with normal renal function undergoing open cardiac surgery.

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We examined the peritoneal net fluid absorption rate (PNFAR) using dextran 70 in 12 children, 8 boys and 4 girls, on peritoneal dialysis. Their average age was 12.5 years (6-17 yr). PNFAR measured using dextran 70 as a marker substance was 2.4ml-7.8ml/kg/4 hours (average 4.9±1.9ml/kg/4 hours). PNFAR measured 1 year later by the same method was 0.9-27.4ml/kg/4 hours (average 7.2±5.9ml/kg/4 hours). There was no correlation and no significant difference between the 2 PNFAR measurements in 12 patients (p=0.20), but a close correlation was observed in 6 patients (r=0.90, p=0.03), who had no residual renal function. We concluded that PNFAR follow-up should be performed separately in patients with residual renal function and in those with no residual renal function.

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A 28-year-old woman on maintenance hemodialysis became pregnant and was admitted to our hospital. She had received hemodialysis therapy for 6 years due to right hydronephrosis and left renal hypoplasia. She exhibited residual renal function and her maximal urine volume was 700ml per day without hemodialysis therapy. Some modifications of her dialysis therapy were introduced after admission, including a frequent dialysis schedule, careful gradual increase of her dry weight, use of rHuEPO, high performance membrane dialysers, and nafamostat mesilate as an anticoagulant. Vigorous obstetric care was also started to prevent uterine infection and constriction. As her pregnancy was maintained without complicating polyhydramnios, therapeutic amniocentesis was not required. She delivered an appropriate-for-date child at the 38th gestational week.
Pregnancies in dialysis patients are relatively rare and are associated with a high risk of miscarriage and preterm delivery. In the present case, residual renal function and early admission likely contributed to maintaining her pregnancy until full-term without serious complications.

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The incidence of urological malignancies in maintenance hemodialysis (HD) patients is higher than that in healthy subjects.
We report here, a case of bladder cancer in a HD patient and discuss the clinical features of bladder cancer in HD patients from case reports in Japan.
A 68-year-old male on HD for 4 years visited our clinic with a complaint of gross hematuria. Cystoscopy revealed multiple tumors in the bladder. Transurethral resection of the bladder tumor was performed, but complete resection was not possible. Then, radical cystectomy and bi-lateral ureterocutaneostomy formation were performed and histopathological examination showed grade 3>2, stage pT 2 transitional carcinoma (TCC). The patient was followed without recurrence, but died due to heart failure 5 months postoperatively.

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Recently, many clinical and experimental observations have linked obstructive sleep apnea, morning headaches, and daytime hypertension. We report a hemodialysis patient who exhibited morning headaches and hypertension due to metabolic alkalosis and sleep apnea. A 55-year-old male had been receiving hemodialysis since 1994. His blood pressure began to increase in June, 1996, and more intensive antihypertensive therapy was needed. Along with the progression of hypertension, morning headaches developed. Occasionally, significant metabolic alkalosis and hypoventilation was noticed when severe headaches occurred prior to hemodialysis sessions. Neurological examination and CT revealed no abnormalities. The headaches were refractory to all analgesics. Continuous respiratory monitoring recorded frequent sleep apnea. A detailed history evaluation disclosed that he had been consuming a large amount of antiacids containing 4.5g of sodium bicarbonate per day. He did not receive antiacids in the hospital ward. Several days later, metabolic alkalosis improved, the frequency of sleep apneic episodes normalized and morning headaches subsided. We concluded that bicarbonate abuse induced metabolic alkalosis, sleep apnea, and morning headaches. Although his blood pressure remained high during the hospitalization, it gradually decreased to hypotensive levels in spite of a relatively large amount of water intake after a few months. This case demonstrates that sleep apnea can cause morning headaches and chronic hypertension, probably due to persistent acceleration of the sympathetic nervous system in hemodialysis patients.

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