L-carnitine facilitates the entry of long chain fatty acids into mitochondria, where they are oxidized to produce energy for muscles and other cells. Insufficient carnitine may lead to an accumulation of fatty acid, which has toxic effects on cell function and may create an energy deficit within cells. Dialysis patients are allowed limited quantities of carnitine-rich food items.
It is a well-known fact that this 162-dalton water-soluble quaternary amine is easily dialyzed, and losses during the dialysis procedure increase the propensity for deficiency and/or depletion. We studied serum carnitine levels in 37 dialysis patients (A hosp: 13 cases, Kt/V=1.67; B hosp: 24 cases, Kt/V=2.24) who were administered L-carnitine^TM at doses of 500-1000mg/day, and measured the dialysate concentration of carnitine to determine whether the supplementary dose of L-carnitine was adequate. Serum lipoprotein changes were examined in 13 dialysis patients at hospital A. Short-term L-carnitine administration increased plasma-free carnitine (FC) and total carnitine (TC) levels, but the AC/FC ratio improved only slighty from 0.84 to 0.69 (normal: 0.16). The deficiency and depletion of carnitine was more significant in patients recieving a large dialysis dose. The concentration of plasma lipids such as HDL, LDL, VLDL, and TG were unexpectedly elevated following short-term carnitine administration. However, in this study the plasma level of Malondialdehyde-LDL (MDA-LDL) decreased significantly, but the decrease in the Oxidized-LDL (OX-LDL) plasma level was not significant. In consideration of all these results, we concluded that a lower dose of carnitine (<5mg/kg, 500mg/every other day) might be more reliable in correcting lipid abnormalities, but the antioxidant effect on lipid metabolism might be weak.

View full abstract

We evaluated serum concentration at dosages of both 5×10⁶ units and 2.5×10⁶ units of interferon administration by i. m. injection in 5 HD patients and 2 non-HD patients to determine the effective dosage and treatment. Serum concentration in HD patients reached a peak 4 to 8 hours after injection. Serum concentration did not differ from that in non-HD patients. Twenty-four hours after injection, 4 of 5 HD patients showed a tendency toward a cumulative serum concentration. The average serum concentration in patients at a dosage of 5×10⁶ units increased to 89.3 IU/ml over 7 days. There were cases showing a maximal concentration of 302 IU/ml among some of the patients receiving that dosage. HD patients showed high levels of AUC. During IFN treatment, GOT increase was detected in all patients. Two patients were excluded due to increased GOT. We suggest changing the dosage used for interferon treatment in HD patients compared to that in patients with normal renal function.

View full abstract

The number of dialysis patients who need life supports care are increasing. Recently, medical-welfare organizations have been developing in Japan. These organizations include hospitals, healthcare facilities for the elderly (HCFE), and special nursing homes for the elderly (SNHE), as coordinated institutions.
Some dialysis patients have been admitted to the facilities of such organizations.
We surveyed these organizations by a questionnaire to determine how dialysis patients are accepted. The result shows: 1. The organizations that have dialysis patients at present, accept them without prejudice. 2. Those without dialysis patients at present hesitate to accept dialysis patients.
The reasons are, staff of the organizations are not familiar with dialysis, or they do not welcome patients who seem to need complicated management.
The desire of dialysis patients is for early entry into such facilities for care and nursing.
We have to educate these organizations that the treatment of dialysis patients is not so different from that of other patients.

View full abstract

Crow-Fukase syndrome (CFS) is a rare multiorgan disorder presenting with polyneuropathy, organomegaly, endocrinopathy, M proteinemia, and skin changes. The pathogenesis of CFS remains unknown. The prognosis of CFS is poor mainly because of heart failure or respiratory failure due to incractable pleural and pericardial effusions and ascites. We report here a case of CFS whose incractable effusions were controlled by intravenous reinfusion of ascitic fluid using the Tenkoff catheter of a CAPD system. A 71-year-old man was hospitalized for abdominal distention, dyspnea, edema and renal impairment due to Crow-Fukase syndrome. Since he had been diagnosed as Crow-Fukase syndrome in 1989, he had been followed in the out-patient clinic in a stable condition for 7 years. In 1996, he developed dyspnea, edema, and abdominal distention, and was admitted on December 5, 1996. Diuretics and albumin were administered for his edema and effusions without any remarkable effects.
Then he underwent peritoneal puncture and drainage. He obtained symptomatic relief for a few days before the recurrence of massive ascites was evident. Since he had undergone peritoneal puncture and drainage once or twice a week, his nutrition alstatus had become poor. Then he underwent Tenkoff catheter insertion and intravenous reinfusion of concentrated ascitic fluid using the Tenkoff catheter of a CAPD system. The patient was discharged in March 1997, and has continued this therapy every 10 days in the out-patient clinic.

View full abstract

Pathomechanism of erythropoietin (EPO) dependent hypertension remained to be elucidated. This study was undertaken to appreciate a participation of two main vasoactive substances, e. g. endothelin (ET-1) and nitric oxide (NOx), in EPO-dependent hypertension.
Plasma level of ET-1 as well s NOx were measured monthly over 3 months after recombinant human erythropoietin (r-HuEPO) therapy in 11 hemodialysis patients. In addition, two vascular markers, e. g. thrombomodulin (TM), tissue factor (TF), were simultaneously determined. Elevation of mean arterial pressure (MAP) more than 5mmHg was found in 5 out of 11 cases after r-HuEPO therapy. Plasma level of ET-1 and NOx showed neither significant variation in time course nor significant difference with variation in MAP after r-HuEPO therapy. ET-1/NOx ratio was slightly, but not significantly, lowered after r-HuEPO therapy in patient whose MAP didn't increase (p=0.116). We also could'nt confirm a correlation between ΔET-1/ΔNOx and ΔMAP. As for plasma level of TM and TF, both of which increased at basal point, but no significant variation could be found through 3 months of r-HuEPO treatment (r=0.314, p=0.076)
Although this study failed to show a clear evidence for the role of either NO or ET-1 in the pathomechanism of EPO-dependent hypertension, we considered it desereved to be studied in clinical setting of more expanding cases.

View full abstract

Aortic calcification is one of the most common features in long-term hemodialysis patients due to poor regulation of calcium. Aortic calcification can be evaluated semi-quantitatively on CT using the aortic calcification index (ACI). We reviewed the progression of aortic calcification over 4 years using ΔACI. In addition, several factors that participate in calcium metabolism, such as Ca×Pi products and PTH, were compared with ACI or ΔACI. Furthermore, we examined the correlation between ACI and the ankle pressure index (API) and/or ST-change of ECG.
The subjects were 50 patients maintained on hemodialysis. ACI was measured over 4 years, between 1991 and 1995. ACI increased progressively with high significance as follows; 10.3±12.4 in 1991, 158±152 in 1993 and 24.8±19.8 in 1995 (p<0.0001). According to the serum level of HS-PTH, all cases were classified into 3 sub-patient groups, the hypoparathyroidism, normoarathyroidism and hyerparathyroidism groups, and ACI was analyzed in each group. Although no significant intergroup difference in ACI ('93) was found, patients in the hypoparathyroidism group demonstrated a significantly higher ΔACI ('93-'95) than that in other groups. In addition, API was 0.96±0.09 and was negatively correlated to ΔACI (r=-0.456, p<0.05). In comparison with the ST-change on ECG, patients who exhibited a ST-change showed slightly higher ΔACI values (n. s.).
In conclusion, we failed to confirm the effect of Ca×Pi products on ACI, but our findings suggested that in some patients, such as those with hypoparathyroidis, aortic calcification may be accelerated.

View full abstract

A 48-year-old male was admitted to wakayama Medical School due to severe liver disorder (GOT 31, 560U/l, GPT 9, 330U/l) and renal failure (BUN 70mg/dl, Cr 6.0mg/dl). On laboratory examination, PT was as low as 11% and a virus marker showed acute hepatitis A. These findings indicated fulminant hepatitis A. Plasma exchange (PE) was performed 3 times, hemodialysis (HD) and hemodiafiltration (HDF) were performed for acute renal failure. PT improved by PE and liver and renal functions improved.
The vast majority of cases of hepatitis A require no specific therapy. However, the intensive liver support by PE must be performed when hepatitis A develops into fulminant hepatitis.

View full abstract