The authors derived a novel simple peritoneal transport equation for small solutes based on the most rigorous Pyle-Popovich's model. Computational curve-fittings were calculated for data generated by the Pyle-Popovich's model using three simple kinetic equations, i.e., Henerso's (no convection), Babb-Garred's (convection from blood to dialysate only), and new model that includes more precise effects of convection, to determine which of these three models returned most accurate MTAC (overall Mass Transfer-Area Coefficient) value. The mathematical forms of these three equations are remarkably similar, although the basic concept or assumptions for derivation are totally different. Slight discrepancies were found between these three models when 4 hr-concentration data were used. Considerable errors, however, appeared with the former two models for data obtained in the case of “UF failure” or “Excess UF”, especially when shorter time (less than 2 hrs) for data collection was used. Even, under such circumstances, the new simple model calculated accurate MTAC values with small error rate (±5.0%). Since analyzing patients' peritoneal function is becoming more important these days, the new kinetic model that requires only PET (peritoneal equilibrium test) data may be a useful tool for calculating MTAC values.

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To determine the effect of lactulose as an antipruritic agent in chronic dialysis patients with severe pruritus, lactulose was administered to 15 patients (10 hemodialysis, 5 CAPD). Four weeks after administration of 16g of lactulose at night, itching severity score decreased from 2.87±0.17 to 1.87±0.22 (p<0.05). Over the following four weeks, the dose of lactulose was increased to 32g (16g at morning and night). The itching score further decreased to 1.60±0.25 (p<0.05). In biochemical findings, there were no remarkable change in the serum level of BUN, calcium, phosphate, total cholesterol, triglyceride, GOT, or GPT. Only creatinine decreased from 12.2±0.5mg/dl to 11.4±0.5mg/dl (p<0.05) in the eight weeks period. We further examined the serum levels of β₂-microglobuline, methylguanidine, guanidinosuccinic acid, indoxyl-sulfate and para-cresol as uremic toxins and pentosidine, an advanced glycosilation end product. All serum concentrations of uremic toxins and pentosidine, except β₂-microglobuline, decreased with the administration of lactulose (p<0.05). These results suggest that lactulose may be useful for chronic dialysis patients as an antipruritic agent.

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To evaluate immnological function in hemodialysis patients, their ability to produce cytokines was studied. The production of interleukin-1β (IL-1β) and tumor necrosis factoryα (TNFα) by peripheral blood monocytes, intrlukin-2 (IL-2) by T lymphocytes and soluble IL-2 receptor (SIL-2R) were determined in the serum of 35 patients and 14 healthy controls. The patients were divided into 4 groups, less than 40 yrs of age with hemodialysis duration less than 1 yr, less than 40 yrs of age with duration longer than 10 yrs, 60 yrs or older with duration less than 1 yr, and 60 yrs or older with duration longer than 10 yrs. Healthy controls consisted of two groups, less than 4 yrs of age and 60 yrs or older. There were no significant difference in the production of IL-1β and TNFα among the two groups. Production of IL-2 was significantly reduced in older patient groups regardless of the duration comirin to the control groups and the younger patient group with a shorter duration of hemodialysis. The younger patient group with a longer duration showed a tendency to have a decreased IL-2 production but the difference was not significant. SIL-2R was significantly increased in all patient groups compared to that in controls. These results suggest that the production of IL-2 by T lymphocytes in the patient group was reduced with age while productions of IL-1β and TNFα by monocytes were not influenced by age or duration of hemodialysis.

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We report a case of pyonephrosis successfully treated by percutaneous nephrostomy and clean intermittent catheterization. A 66-year-old female, who had undergone radical hysterectomy and radiation therapy in 1967 and maintained on hemodialysis since 1987, was admitted to our hospital because of right flank pain and low grade fever in July 1996.
Abdominal CT revealed a solid mass in the right renal pelvis, bilateral hydronephrosis and extremely enlarged bladder. We diagnosed right renal bleeding and bilateral hydronephrosis due to neurogenic bladder caused by radical hysterectomy. Antibiotics were administered and clean intermittent catheterization and bladder washout were performed. Percutaneous nephrostomy was performed on August 8 because of high fever. After pyonephrosis was resolved, percutaneous biopsy of the right renal pelvis revealed grnulous tissues.
The nephrostomy tube was removed on November 9, 1996. We conclude that pyonephrosis could be resolved conservatively with percutaneous nephrostomy and intermittent catheterization in neurogenic bladder patient on long-term hemodialysis.

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Questionnaires were sent to 2, 622 dialysis units in February 1996, to determine the current prevalence of renal cell carcinoma in chronic hemodialysis patients. The response rate was 59.5%. Renal cell carcinomas were detected in 277 dialysis patients between March 1994 and February 1996. The mean age of these 277 patients (222 males and 5 females) was 54.1±11.7 (mean±SD) years, and the mean duration of dialysis was 125.8±79.5 months. Clinical diagnosis was based on sonograhic examination (140 case) and CT scan (112 cases). Only 10 of those patients were symptomatic. Acquired renal cystic disease was found in 222 of 271 renal cell carcinoma patients (81.9%). In 242 cases, renal cell carcinoma was histologically confirmed. Cell typing of 218 renal cell carcinomas revealed that 123 were the clear cell subtype, 44 granular cell subtype and 51 mixed cell subtype. Structural typing of 205 renal cell carcinomas showed that 67 were alveolar, 29 tubular, 49 papillary, 20 cystic, 14 solid and 26 mixed. Granular or mixed cell subtype and tubular or papillary structure were prevalent among patients with more than 5 years of hemodialysis. Forty-five of 273 patients demonstrated metastasis. Two hundred seventy-seven renal cell carcinomas were detected during the two years preceding this survey and the prevalence was the highest incidence documented in the seven most recent questionnaires. The incidence of renal cell carcinoma in dialysis patients was 12 to 15 times higher than that in the general population. The incidence of renal cell carcinoma in dialysis patients was 163 renal cell carcinomas per 100, 000 dialysis patients per year. In conclusion, renal cell carcinoma accompanied by acquired renal cystic disease in long-term hemodialysis tends to develop in a granular or mixed cell subtype and tubular or papillary structural pattern.

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To investigate the phracokinetics of isosorbide-5-mononitrate (ISMN) in hemodialysis patients, 20mg of ISMN was administered twice a day to six chronic hemodialysis patients with ischemic heart disease. Beginning more than three days after the administration, blood samples were taken periodically to determine the ISMN blood concentration. The blood concentration of ISMN on non-hemodialysis day was extremely high, and a decrease in the distribution volume was suggested to be the main cause. The elimination rate of ISMN was almost 80% during hemodialysis, however the blood concentration of ISMN remained within the therapeutic range after hemodialysis.
It was concluded that no dose adjustment appeared necessary in hemodialysis patients, although the blood concentration of ISMN was influenced by hemodialysis.

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Three hundred and four chronic renal failure patients (173 males, 131 females) given maintenance HD treatment at Narita Memorial Hospital and two affiliated institutions, were studied in this investigation of fractures in hemodialysis (HD) patients. Fractures of patients since they began HD therapy were surveyed in the period between February 25 and May 31, 1995. The results showed 47 patients (30 males, 17 females) had a history of fractures. Fractures were found in a total of 37 males and 27 females. In both sexes, fractures were more common in the third decade or younger, rather than among elderly patients 60 years or older. The incidence of fractures (%) in both sexes significantly increased with the individual history of HD treatment (years) and showed a high positive correlation (r>0.9). Fracture locations were as follows: ribs, the most common fracture, in 9 males and 11 females; followed by fractures of the clavicle, scapula and heel (5 cases each among males); and forearm, femur and toe fractures (3 cases each among females). In males there were 5 cases each of fracture of the scapula and heel, neither of which is markedly affected by osteoporosis. Not even one such fracture was found among females. The most frequent pathological fracture among both sexes involved the ribs. No significant sex difference was found in any age bracket in the incidence of fractures. There was no significant sex difference on total body bone mineral density using Z score analysis. Based on the above-mentioned findings, it was conspeculated that aside from bone mineral density, daily life activity is one of the factor that increases the incidence of fractures.

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The patients with end-stage renal disease on maintenance hemodialysis occasionally develop serious concomitant diseases which require hospitalization. The incidence of psychosis seems to be slightly increased in patients on maintenance hemodialysis. One hemodialysis patient with recurrence of atypical psychosis was admitted to a psychiatric ward. We encountered great difficulty in making arrangements for admission to a general hospital with both an isolation ward for psychotic patients and a hemodialysis center. The patient was finally admitted to a professional psychiatric hospital located one hour by car from our hospital, and hemodialysis treatment was carried out at the out-patient clinic in our hospital. Two nursing staff accompanied him on the way to and from our hospital.
A questionnaire surveying the circumstances of hospitalization for patients with concomitant end-stage renal disease and psychosis was sent to all hemodialysis units in Aichi prefecture. The questionnaire inquired regarding the prevalence and type of psychoses encountered during the last one year, the inevitability of hospitalization, problems in the process of admission and the consequences, problems during hemodialysis treatment and nursing plans. Responses were collected from 72 (65%) of 111 hospitals. Among 4, 418 uremic patients, 62 patients (1.4%) with psychosis were enrolled in the analysis. The most common psychosis was manic-depressive illness (n=24), and the second most common was sizophrenia (n=14) and the third was senile dementia. Regarding age distribution in uremic patients with psychosis, the highest prevalence was found among those in their fifties. Hospitalization was indicated in 20 (32%) of 62 psychotic patients. Only five patients were admitted to a general hospital where professional treatment in a psychiatric ward and hemodialysis were both available in the same hospital. Fifteen (75%) of 20 patients had several problems in the process of admission. Six patients were admitted to professional psychiatric hospital, and had to be transported to other hospitals as outpatients for hemodialysis. Six other patients were admitted to ordinary wards in hospitals without professional psychiatric ward. The remaining three patients were not admitted to any hospital. Several nursing plans; isolation, sedation during hemodialysis, restriction, attendance by family and/or an exclusive nursing staff and so on, were necessary for safe hemodialysis treatment.
A regional network is urgently needed to provide optimal therapy for hemodialysis patients with serious complications including psychosis.

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[in Japanese]

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