The skin surface pH-acid mantle may play a role as a protective barrier against infection. We investigated the relationship between skin pH and exit-site infection (ESI) in patients on CAPD. 1) Forearm skin pH was 5.04±0.47 (n=37) in CAPD patients, 5.20±0.40 (n=31) in HD patients, and 4.65±0.46 (n=38) in healthy subjects. Patients on dialysis (CAPD and HD) showed significantly higher skin pH than healthy subjects. 2) In CAPD patients, skin pH measured at the forearm, abdominal wall, and exit site were well correlated with each other. 3) A substantial correlation was found between the severity of ESI and skin pH in CAPD patients.
The present study showed that the skin of CAPD patients has a higher pH than that of normal subjects, suggesting an impaired skin surface pH-acid mantle. Furthermore, CAPD patients with a higher skin pH may be more susceptible to ESI.

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Purpose: We mathematically analysed the blood volume change during hemodialysis by continuous hematocrit monitoring using CRIT-LINE (IN-LINE DIAGNOSTICS). Methods: We measured the hematocrit and calculated the blood volume change (%BV) in eight chronic hemodialysis patients, 5 hemodialysis sessinons in each patient and studied the method of approximating %BV using the equation: %BV=b×[1-exp(cX)]-aX. Furthermore, we studied the relationship between the coefficients (a, b, c) and clinical parameters.
Results: 1) Hematocrit decreased just after the start of hemodialysis and gradually increased from about 1 hour to the end of hemodialysis. Just after the start of hemodialysis, %BV increased then started to linearly decrease after about 1 hour and continued to decrease until the end of hemodialysis. 2) We approximated the linear part of %BV to the equation: y=b-aX and the curved part of the equation: y=b×[1-exp(cX)] and then gained a good correlation (r>0.95) in each part of %BV. Thus, we could approximate %BV to the equation: y=b×[1-exp(cX)]-aX. 3) Coefficient a, the slope of the linear part of %BV was 0.0859±0.0051. Coefficient b, the degree of increase of %BV, was 5.948±0.433. Coefficient c, the speed of increase of %BV, was -0.0396±0.0028. 4) As for the relationship of each coefficient to the clinical parameters, only coefficient a was significantly related to the volume removed during hemodialysis (r=0.50, p<0.05). Conclusions: %BV could be approximated to the equation: %BV=b×[1-exp(c×Time)]-a×Time. However, further studies will be needed to analyse the clinical importance of each coefficient.

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Persistent exit site infections and chronic tunnel infections are the main complications related to peritoneal dialysis catheter. Usually these complications are managed by antibiotic administration, unroofing and/or cuff shaving, but sometimes these therapeutic approaches are not effective.
After the catheter has been used for a prolonged period, it becomes fragile and carries a risk of breaking down.
Thus, we have devised a partial replacement system for peritoneal dialysis catheters thatinvolves splicing a new external segment furnished with a Dacron cuff to original catheter.
We applied this approach to ten patients (eight persistent tunnel infections, two fragile catheters used for ten years). In one case, we removed the original catheter and re-implanted a new one because the original catheter broke during surgery. In all other patients, the usual peritoneal dialysis could be restarted immediately after surgery.
There are some reports describing partial replacement of the peritoneal dialysis catheter for persistent exitsite infection or chronic tunnel infection, but these procedures were expensive. We conclude that our procedure is as useful as other procedures reported previously but the cost is lower.

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This study was performed to analyze factors affecting, patency and rate of complications of saphenous vein grafting for blood access in hemodialysis. Thirty-nine patients (40 procedures) who underwent implantation surgery between August 1989 and May 1997 in our hospital were studied. Patients were 26 to 84 years old (average 61 years old). The primary diseases were diabetic nephropathy in 17, chronic glomerulonephritis in 7, collagen disease in 4, and other in 11. Between August 1989 and May 1997, 21 patients survived, and 18 patients died.
The patency periods in surviving patients ranged from 0 to 62 months, with a mean of 22 months. The patency periods of non-surviving patients ranged from 0 to 49 months, with a mean of 11 months. The overall patency rate was 56% at 1 year, 52% at 2 years, and 21% at 5 years, the longest patency was 62 months. The patency rate in 26 cases (survival over 1 year) was 100% at 1 year, 85% at 2 years, and 32% at 5 years. Seventeen of 39 patients who received saphenous vein grafting had diabetic nephropathy. One case required PTA (percutaneous transluminal angioplasty) prior to occulusion, and the PTA was successful.
In conclusion, the auto-saphenous vein grafting is a useful means of achieving long-term patency with relatively easy maintenance.

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It has been suggested that lipid abnormalities may be involved in the development of cardiovascular events (especially, coronary artery disease) in patients on maintenance hemodialysis (HD). Hypertriglyceridemia commonly accompanies this condition and is associated with decreased HDL-cholesterol levels. Recently, clinical attention has been focused on disturbances in Lp (a) in relation to cardiovascular events. Although high Lp (a) levels are associated with coronary artery disease, such data concerning HD patients appears limited. We therefore studied whether Lp (a) levels per se in HD patients is an independent risk factor from coronary artery disease.
Lp (a) were measured in 268 HD patients (chronic glomerulonephritis, N=212; diabetic nephropathy, N=56). The prognosis of these patients was investigated for up to 5 years. The death rate in HD patients during the follow-up period was 26.1%:70.0% involved cardiovascular events. HD patients who died of cardiovascular events had significantly higher Lp (a) level than those died of non-cardiovascular events. The relative risk of death from coronary artery disease was 0.71 in HD patients with Lp (a) levels above 30mg/dl.
Lp (a) levels can predict the subsequent risk of death from coronary artery disease in HD patients.

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We report a 52-year-old male undergoing CAPD who developed varicella-zoster virus (VZV) encephalitis. Because of the preceding herpes zoster, the patient was given acyclovir (ACV) per os, and thereafter disturbances of the central nervous system emerged. Thus, we had to distinguish between ACV encephalopathy and VZV encephalitis. However, based on the findings of Auditory-brainstem-response and lumbar puncture, we strongly suspected it as VZV encephalitis. Thus, intravenous ACV therapy was initiated again. One week later, the diagnosis of VZV encephalitis was confirmed by the evidence of rising anti VZV-IgG antibody titer in the cerebrospinal fluid. Two months later, the patient recovered completely from VZV encephalitis without any complications. There seem to have been no reports of VZV encephalitis in CAPD patients.
To clarify the pharmacokinetics of ACV in CAPD, 5mg/kg of ACV was intravenously administered to this patient and the blood concentration of ACV was serially measured. This dose was considered too high for the CAPD patient. Thus, daily administration of 2.5mg/kg or alternative day administration of 5.0mg/kg was thought to be effective and safe for CAPD patients with VZV infection.

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Percutaneous transluminal angioplasty for stenosis of the hemodialysis fistula has rapidly become a wide spread method of maintaining vascular access. However, extremely rigid stenotic lesions around hemodialysis fistula are not often completely dilated by maximal balloon pressure. Such insufficient dilatation of the stenotic lesion may cause early restenosis and blood flow insufficiency. We describe two cases treated by the parallel wire technique for complete dilatation of a severely rigid stenotic lesion around a hemodialysis fistula. This technique has sometimes been used for percutaneous transluminal coronary angioplasty.
Case 1: A 64-year-old man was examined because of decreased vascular sound in the hemodialysis fistula. Angiography of the hemodialysis fistula revealed a 73% diameter stenosis. This lesion was incompletely dilatated at 12 atmospheres (atms.) of the balloon, which was rated burst pressure and the balloon showed indentation. Thereafter, we tried the parallel wire technique to treat this rigid lesion. After parallel bare wires were inserted using a sheath balloon angioplasty was performed again at 12 atms. The rigid stenotic lesion was dilated successfully by this technique.
Case 2: A 68-year-old man presented with decreasing blood flow (<120ml/min.) through the hemodialysis fistula. Angiography revealed a 85% stenosis in a long segment of the fistula. As in case 1, the stenotic lesion was not dilated completely at 12 atms. of balloon burst pressure, but was dilated successfully at 10 atms. by the parallel wire technique. After these procedures, there has been no sign of restenosis in the dilated portions and there is sufficient blood flow through the fistula in both cases. This technique for treating rigid stenosis of hemodialysis fistula is useful and may be able to reduced the incidence of restenosis after percutaneous transluminal angioplasty.

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