Nihon Toseki Igakkai Zasshi
Online ISSN : 1883-082X
Print ISSN : 1340-3451
ISSN-L : 1340-3451
Volume 31, Issue 1
Displaying 1-10 of 10 articles from this issue
  • [in Japanese]
    1998 Volume 31 Issue 1 Pages 1-24
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    In 1996, the Japanese Society for Dialysis Therapy conducted a statistical survey of 2, 968 facilities in Japan and received replies from 2, 961 facilities (99.76%). As of the end of 1996, there were 167, 192 dialysis patients in Japan, an increase of 12, 779 patients (8.3%) over a year from the end of 1995. The gross mortality rate was 9.4%, a slight improvement over the previous year.
    The mean age of the patients who started their dialysis therapy in 1996 was 61.51 years old (±14.16 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 1996 decreased compared to last year. This is 38.9% out of all the patients who started dialysis in 1996. On the other hand, the patients who started dialysis due to diabetic nephropathy increased, and their percentage was 33.1%.
    In 1996, the survey also covered the history of the surgical release of carpal tunnel, intact parathyroid hormone (intact PTH) level, pre-dialysis pH level, pre-dialysis HCO3- level and hemoglobin A1c (HbA1c) level. Surgical release of carpal tunnel was experienced by 5.0% of hemodialysis patients, and their number increased as the years on hemodialysis became longer. The intact PTH level, pre-dialysis pH level, pre-dialysis HCO3- level means (±S. D.) were 296.5 (±796.5) pg/ml, 7.34 (±0.15), 20.09 (±3.43) mEq/l, among hemodialysis patients; and the mean HbA1c level was 6.80 (±1.64)% in hemodialysis patients with diabetes mellitus.
    Analysis of the prognosis suggested a high death risk in groups with a pre-dialysis cardio-thoracic ratio of 50% or more, or a dialyzer membrane surface area of less than 2.0m2.
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  • Kazuko Yokoyama
    1998 Volume 31 Issue 1 Pages 25-29
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
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  • Tomohiko Naruse, Yuzo Watanabe, Akira Itoh, Chikao Yamazaki, Daijo Ina ...
    1998 Volume 31 Issue 1 Pages 31-36
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    To identify risk factors for destructive spondyloarthropathy (DSA) in hemodialysis patients, we performed a cross-sectional study of 314 patients undergoing long-term hemodialysis. DSA was found in 40 patients (12.7%), and occurred predominantly at the cervical spine, particularly between the 4th and 6th vertebrae (80%). Comparison of patients with DSA and without DSA indicated that patients with DSA were older, and that the duration of hemodialysis was longer in these patients than in those without DSA (61.2±1.5 vs 55.6±0.7 years old, P=0.005, 119±10 vs 91±4 months, P=0.007). DSA was also found in 9 patients with a history of hemodialysis of less than 6 years. Among the various parameters related to bone disorder, the existence of bone cysts and carpal tunnel syndrome were found to be significant risk factors for developing DSA (X2=35.2, P<0.0001; X2=12.4, P=0.0004; respectively), whereas no risk was observed with secondary hyperparathyroidism, hypoparathyroidism and osteoporosis. These results suggest that patients with a history of long-term dialysis and those with an advanced age are candidates for DSA. Furthermore, a close relationship between dialysis-related amyloidosis and DSA was suggested. Multivariate analysis revealed that only the bone cyst formation and the advanced age were significant risk factors for development of DSA; long-term hemodialysis and carpal tunnel syndrome were not selected. These results suggest that long-term hemodialysis might not be essential for the development of DSA. The patients who developed DSA despite a short hemodialysis history were aged (64.6±3.9 years), and the proportion of aged patients among those who newly started hemodialysis is increasing. Therefore, close examination of each patient is important to prevent the serious complications accompanied with severe DSA.
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  • Osamu Sasaki, Takashi Harada, Masanobu Miyazaki, Yoshiyuki Miyahara, Y ...
    1998 Volume 31 Issue 1 Pages 37-43
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    The number of patients on chronic hemodialysis has increased in recent years. Therefore, arteriosclerosis should be considered carefully as a serious complication in such patients. Surgical treatment of abdominal aortic aneurysm (AAA) and/or arteriosclerosis obliterans (ASO) may be necessary in some patients. The management of AAA and ASO in patients on chronic hemodialysis is very important, because it affects prognosis and quality of life, particularly in patients with the above complications. In the present study, we examined the clinical features of AAA (n=4) and ASO (n=3) and evaluated the clinical outcome of arterial reconstruction for AAA and ASO in our hospital.
    Patients with AAA were aged 45 to 61 years and all had secondary hypertension and had been on hemodialysis for 6 to 60 months. Two patients complained of abdominal or back pain but the other two, in whom AAA was detected coincidentally on palpation of the abdomen, were asymptomatic. All aneurysms were infrarenal in type. Arterial reconstruction was performed by Y graft replacement in three patients and straight graft replacement in one patient. The condition improved in all patients after surgery.
    Patients with ASO, aged 51 to 67 years, had been on hemodialysis for 64 to 231 months, and two were hypertensive. All three patients presented with symptoms and findings such as leg pain, intermittent claudication and necrosis of foot. Angiography showed obstruction of the left iliac-popliteal arteries in two patients and obstruction of the right common-external iliac arteries in one patient. Arterial reconstructive surgery was performed by femoro-popliteal bypass using the vena saphena magna in the former two patients and by femoro-femoral crossover bypass which was repeated twice in the latter case. The postoperative course was satisfactory in one patient but the other two died due to other diseases.
    Recent advances in surgical techniques and management of hemodialysis before and after operation have facilitated surgical treatment of patients with chronic hemodialysis. However, the outcome in hemodialysis patients with ASO is poor and a thorough investigative workup of the choice of therapy and general state should be performed before surgery.
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  • Munekazu Ryuzaki, Masahiro Matsushita, Michiko Handa, Tomohiro Furukaw ...
    1998 Volume 31 Issue 1 Pages 45-51
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    The efficacy and elimination of amlodipine were evaluated in hypertensive hemodialyzed patients (n=19). After 2 to 4 weeks of observation, 2.5 to 7.5 mg/day of amlodipine were administered. The changes in blood pressure (BP) and heart rate (HR) were measured before and after hemodialysis (HD). The serum concentrations of amlodipine just before each HD were measured at 1, 2, and more than 4 or 12 weeks after the start of amlodipine. The clearance and reduction rates of amlodipine by HD were measured at more than 4 or 12 weeks after the initiation of amlodipine. The patients took amlodipine after dinner everyday. The other antihypertensive medications had not been changed throughout the study.
    In 15 patients taking 5mg/day of amlodipine, at the observation period BP was 199±4/95±3mmHg. After administration of amlodipine BP significantly decreased at week 1 and remained low throughout the study period (at week 12, 170±5/83±3mmHg; p<0.05). HR significantly decreased from 81±2 to 75±2 beats/min at week 1. After 2 weeks, there were no significant changes in HR. The serum concentrations of amlodipine before HD were 6.8±0.8ng/ml at week 1, 7.1±0.7 at week 2, 8.1±1.0 at more than 4 weeks, and 8.6±1.2 at more than 12 weeks, but there were no significant differences between these values. The clearance values were negative, but reduction rates were between 14 to 18%. The serum concentrations of amlodipine just after HD were significantly lower than those before HD or the calculated predicted values. As a result, amlodipine was thought to be eliminated partially by HD. In conclusion, long-term administration of amlodipine was considered to be effective and safe without accumulation even in hemodialyzed hypertensive patients.
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  • Shinichiro Watanabe, Sumihiro Shirai, Kazuaki Soejima, Akira Tajima, H ...
    1998 Volume 31 Issue 1 Pages 53-56
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    We performed a retrospective study to determine the prognosis of hemodialysis patients who suffered from gangrene and underwent amputations of the lower extremities or fingers. Between 1991 and 1997, 7 male patients and 5 female patients were operated upon. The average age was 71 years old. As causes of gangrene, arteriosclerotic obstruction (ASO) was suspected in 9 patients and diabetes in 10 patients. The site of amputation was above the knee in 4 patients, at the knee joint in 1, below the knee in 8, at the metatarsus in 2, the toe in 5 and the finger in 2. Echocardiography was perfomed on 10 patients and 7 patients had hypokinesis of the ventricular wall. These 7 patients were also found to have coronary heart disease by cardiac catheterization. The 1 and 2-year survival rates of all patients were 54 and 40% respectively. The 1 and 2-year survival rates of patients who did not have coronary heart disease (75 and 50%, respectively) were better than those of patients who had coronary heart disease (62 and 31%, respectively). Two patients who only had one toe amputated did not die but the prognosis of others who were amputated above the metatarsus was poor: The 1 and 2-year survival rates were 42 and 28% respectively. The serum urea nitrogen, creatinine and albumin levels of the amputated patients were statistically lower than those of the hemodialysis patients who did not suffer from gangrene.
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  • Masahiko Kawabata, Shu-ji Kasuga, Tetsuya Ogawa, Sin-ichirou Suyama, K ...
    1998 Volume 31 Issue 1 Pages 57-62
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    Hemodiafiltration (HDF) therapy develops less intradialytic symptoms than hemodialysis (HD). By continuously monitoring the hematocrit in extracorporeal circulation, we assessed changes in circulating blood volume during HD and HDF in nine patients on regular dialysis. The total decrease in blood volume was significantly more in HDF than in HD therapy (-18.2±0.9 vs. -15.0±1.2%) although the fluid volume removed during the therapy was comparable. In HDF, the blood volume reduced sharply in the early half of the therapy and the reduction at the mid point was 49.5±2.5% of the total. In HD, the reduction was 41.1±3.0% at the mid point and was sharp in the latter half. Serum concentrations of urea nitrogen, creatinine and human atrial natriuretic polypeptide were not different between HD and HDF. At the mid point of the therapy, however, hematocrit and serum protein concentration were higher, and osmolarity and sodium concentration were lower in HDF than in HD. These results indicate that, during the first half of HDF therapy, circulating blood is more concentrated than during HD probably because of less plasma refilling from the extravascular space into vessels. Higher plasma oncotic pressure due to hemoconcentration may maintain high plasma refilling rates in the latter half of the therapy and thus be of benefit to the hemodynamic stability in patients. During HD, a larger part of the reduction in blood volume was observed in the latter half, which may be one of the reasons why intradialytic symptoms or hypotension tends to occur in this phase of the therapy.
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  • Matahiro Yabuta, Katsusaburo Kamada, Yuta Yamamoto, Norihiko Matsumura ...
    1998 Volume 31 Issue 1 Pages 63-67
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    We describe two patients who developed pyogenic vertebral osteomyelitis while on maintenance hemodialysis for end-stage renal failure due to chronic glomerulonephritis.
    One patient, a 62-year-old man, suffered from a shunt infection which was successfully treated with antibiotics after 12 years on hemodialysis. Two months later he was admitted to our hospital complaining of lumbago and fever. His symptoms did not respond to medication with antibiotics. Half a year later he was diagnosed as having pyogenic vertebral osteomyelitis and a surgical drainage was performed. A culture of the drained specimen yielded Staphylococcus epidermidis.
    The other patient, a 67-year-old man, complained of fever one month after the start of hemodialysis using a double lumen catheter. The blood culture yielded MRSA, which disappeared from a subsequent blood culture after treatment with antibiotics. However, five months later, the patient complained of lumbago and two months after that he was diagnosed as having pyogenic vertebral osteomyelitis. A needle vertebral biopsy was taken and the culture of the biopsy specimen yielded MRSA. His back pain abated after therapy with intravenous vancomycin for 3 months.
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  • Masahiko Shinohara, Akito Maeshima, Kenichi Amamiya, Yukiko Abe, Akiya ...
    1998 Volume 31 Issue 1 Pages 69-72
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    A 32-year-old man, complicated with chronic hepatitis C, had been on peritoneal dialysis since Feb. 1995. He was admitted to our hospital for treatment of chronic hepatitis C by interferon. After several treatments with hemodialysis, we carried out a liver biopsy and administered interferon alpha-2a. The primary dosage was 6MU per day for the first 14 days, followed by 2 doses per week for 6 months. After 35 administrations of interferon, we stopped the treatment because of side effects including renal dysfunction, involuntary movement and depression. The maximum serum concentration of interferon had risen due to accumulation from continuous administration. Though the pretreatment titer of serum HCV-RNA was 105 copies/50μl, it became negative after two months of administration of interferon, and remained negative for six months after discontinuance. It was concluded that interferon therapy was an effective treatment for this peritoneal dialysis patient with chronic hepatitis C, if the dosage is reduced to minimize side effects.
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  • Fumitake Gejyo, Hideki Kimura, Yoshindo Kawaguchi
    1998 Volume 31 Issue 1 Pages 73-78
    Published: January 28, 1998
    Released on J-STAGE: March 16, 2010
    JOURNAL FREE ACCESS
    In order to know the present state of low-dose steroid treatment for articular symptoms of dialysis-related amyloidosis, we have carried out a questionnaire survey for 102 facilities. These facilities were chosen from training facilities of the Ministry of Health and Welfare of Japan for people who are engaged in dialysis medicine, and facilities authorized by the Japanese Society for Dialysis Therapy, one from each prefecture. We have received answers from 78 facilities (76.5%). In these facilities, there were 10, 760 patients of dialysis, 2, 912 of them had received dialysis treatment over ten years, and 1, 225 of them had complications of dialysis-related amyloidosis. Among the 68 facilities in which complications of dialysis-related amyloidosis were reported, 56 facilities, more than 80%, had carried out medication for arthralgia of dialysis-related amyloidosis and only 12 ones did not do this treatment. Adrenocortical steroid (steroid) had been used in 33 of the 68 facilities (48.5%), and 140 patients had been treated with steroid. This was 11.4% of the total 1, 225 patients of dialysisrelated amyloidosis. On the side effects of steroid treatment, 15 cases were reported from 8 facilities out of 33 facilities. The most noticeable side effects were the 3 cases of infection, one was dead, the other two had to be in hospital for several weeks. On steroid treatment for dialysis patients, it is necessary to pay attention to infection, and to adjust the adaptation to an appropriate level. Our research team has proposed a guideline, that is, “the guideline to the low-dose steroid treatment on articular symptoms of dialysis-related amyloidosis”, which is very helpful to this respect.
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