In 1997, the Japanese Society for Dialysis Therapy conducted a statistical survey of 3, 035 facilities in Japan and received replies from 3, 026 facilities (99.70%). As of the end of 1997, there were 175, 988 dialysis patients in Japan, an increase of 8, 796 patients (5.3%) over a year from the end of 1996. The gross mortality rate was 9.4%, the same as the previous year.
The mean age of the patients who started their dialysis therapy in 1997 was 59.2±13.4 years old (±S.D.). This shows that the age of dialysis patients was higher than the previous year. The patients who started dialysis due to chronic glomerulonephritis in 1997 decreased compared to a year earlier. This accounts for 36.6% out of all the patients who started dialysis in 1997. On the other hand, the patients who started dialysis due to diabetic nephroathy increased, and their percentage was 33.9%.
In 1997, the survey also covered the high-sensitive parathyroid hormone (HS-PTH) level, C-terminal parathyroid hormone (C-PTH) level, alkaline phosphatas (ALP) level, pre-dialysis serum calcium concentration, vitamin D₃ dose administered and whether or not a prathyroidectomy had been performed. Some 45.3% of the responding patients had been administered vitamin D₃, and 3% had undergone vitamin D₃ pulse therapy. Among the patients surveyed as to a previous paratyroidectomy, 4.4% responded in the affirmative, and 0.2% had undergone percutaneous ethanol injection therapy (PEIT).
Analysis of the prognosis suggested a high death risk in groups with an intact parathyroid hormone level of 720pg/ml or more, a hemoglobin Alc level of less than 5% or over 9%, pre-dialysis blood pH exceeding 7.43, or a predialysis blood HCO₃^- level of less than 16mEq/l or over 26mEq/l.
Analysis of risk factors contributing to the need for surgical release of carpal tunnel syndrome revealed a long dialysis history of ten years or more, an aging among the risk factors.

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We examined the usefulness of the single-pass batch dialysate delivery system for home hemodialysis (HD). There are 2 methods to prepare dialysate, continuous preparation and pretreatment preparation. We selected pretreatment preparation since it is more economical and produces dialysate with a more stable electrolytic composition than the continuous preparation. Then, we theoretically compared the dialysis efficiency of 2 dialysate circulation methods, the single-pass method and the recirculation method, and the dialysis efficiency was found to be superior in the former method than in the latter. When the blood flow rate (Qb) was 200ml/min and the overall mass transfer-area coefficient of the dialyzer was 600ml/min, the dialysate volume of 60 liters, 3 times week for 240 min HD was necessary to achieve the weekly dialysis dose of KT/V=3.6 for a patient with a urea distribution volume of 30 liters determined by the single-pass method. Based on this preliminary information, we performed the single-pass batch 3 times a week HD with a Qb of 200 and a dialysate flow rate (Qd) of 250ml/min in 2 chronic renal failure patients and compared the dialysis efficiency to that by conventional HD with a Qd of 500ml/min. The dialyzer used was polysulfone with a surface area of 1.6m². To evaluate the dialysis efficiency, we analyzed the kinetics of urea and creatinine by variable-volume 2-compartment model. Although there were no significant differences between the 2 HD treatments in the time-averaged concentrations of the 2 solutes, the lower Qd resulted in a 10% decrease in the equilibrated KT/V (KT/Ve) of urea (0.943 vs. 0.352, P=0.053) and 5% decrease in the KT/Ve of creatinine (0.709 vs. 0.676, P=0.153). The decrease in KT/Ve of urea was estimated to be compensated by the 30 min added to the treatment time for 240 min HD.
It was concluded that the single-pass batch dialysat delivery system with a Qd of 250ml/min is useful for home HD. The batch volume of about 80 liters for the 3 times a week HD was considered appropriate for longer treatment times up to 300 min.

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A 60-year-old female received hemodialysis for 9 years in our dialysis unit. At the end of 1995, percutaneous ethanol injection therapy (PEIT) into the adenomatous parathyroid gland started due to severe secondary hyperparathyroidism. In the course of the PEIT, dyspnea gradually developed despite reduction of her dry weight. She was hospitalized for refractory congestive heart failure, at which time the diagnosis of hyperthyroidism due to Graves' disease was made. Therapy, 20mg of thiamazole every day for 1 month, resulted in improvement of heart failure after normalizing the thyroid function.
We investigated the serum concentration of thiamazole to clarify the appropriate dose for patients with ESRD. The data showed its delayed absorption, prolonged half life and dialyzability. Based on these findings, we concluded that thiamazole should be administered to patients after dialysis with reduced doses in Graves' disease.

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Refractory ascites are sometimes observed in patients receiving maintenance hemodialysis. The common causes are known to be volume overload due to congestive heart failure, liver cirrhosis, or peritonitis. We reported a 72-year-old woman who developed refractory and massive ascites due to hypothyroidism 1 month after the initiation of hemodialysis therapy. In the present case, the diagnosis of myxedema ascites was difficult because, 1) the symptoms and signs specific for hypothyroidism were absent despite marked hormonal depletion (free T₃; 0.7pg/ml, free T₄; 0.28ng/dl, and TSH; 170μU/ml), 2) hypothyroidism rarely causes massive ascites, 3) nonspecific symptoms of hypothyroidism are similar to those of uremia. The ascites disappeared after replacement therapy with levothyroxine sodium for months. Myxedema ascites are rare but should be considered in the differential diagnosis of refractory ascites in the hemodialyzed patients.

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An 82-year-old man started hemodialysis at our hospital in September 1992 to treat renal failure due to chronic glomerular nephritis. Since the end of December 1996, the patient demonstrated anorexia, and was admitted to our hospital on January 16, 1997 because of dysbasia, high fever, ingestion failure and a decreased level of conciousness. Pneumonia was diagnosed based on chest X-P. The WBC (white blood cells) count was 8, 200, CRP (C-reactive protein) was 8.9mg/dl, and CK (creatinine kinase) was 538IU/l, showing slight increases. There were no unusual findings on cephalic CT. On January 17, LDH (lactate dehydrogenase) was 737IU/l, CK was markedly increased at 1, 467IU/l and CRP was 8.3mg/dl. There were no findings of myocardial infarction on ECG or echocardiography. On January 20, CK was normalized at 109IU/l. On January 22, his level of consiousness was such that he opened his eyes when he was spoken to. Although he had taken levodopa/carbidopa for Parkinson's disease prescribed by a local hospital since 1991, he had not taken any levodopa for 1 week before admission. Based on the impaired consciousness, high fever and high CK level, we diagnosed the patient with malignant syndrome due to discontinuation of dopaminergic medication. Therefore, oral administration of levodopa/carbidopa was initiated. His level of consciousness gradually increased, and at the end of February, his consciousness recovered to a level similar to that before admission. The causes of this crisis were considered to be discontinuation of anti-parkinsonism drug medication, pneumonia and malnutrition.
It is clearly important to improve the overall condition, and medication with levodopa should be continued during severe illness.

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We present a case of renal cell carcinoma with spontaneous retroperitoneal hemorrhage. The patient was a 34-year-old male who received peritoneal dialysis for 5 years. He was admitted to our hospital with severe right flank pain. CT revealed retroperitoneal hemorrhage around the right kidney. We performed a right radical nephrectomy.
Histopathological diagnosis was renal cell carcinoma with ACDK, papillary type, clear cell subtype, grade 1, INF-α, pT₁, pV₀.
The patient has been well without local recurrence or distant metastasis for 1 year after the surgery.

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We report 3 cases of arteriosclerosis obliterance (ASO) that were complicated by renal failure and required hemodialysis (HD), probably caused by atheromatous embolisms. All patients were male and were between 70 and 74 years of age. The first case presented pulmonary infarction and acute renal failure 13 days after coronary angiography (CAG). He was immediately treated with intravenous alteplase and heparin injection, but the circulation deteriorated in his extremities. Finally, he died of multiple organ failure 18 days after CAG. Atheromatous embolism was identified by autopsy. The second case exhibited cerebral infarction during percutaneous transluminal coronary anioplasty (PTCA). He was treated with aspirin and warfarin but ischemic lesions developed in his foot and progressively worsened. His renal function gradually deteriorated and HD was introduced 78 days after PTCA. The third case demonstrated acute obstruction of the left femoral artery during a Y-graft replacement operation for abdominal aortic aneurysm. Emergency thrombectomy was successful, but he could not walk due to severe foot pain with cyanosis and livedo reticularis 3 months after the operation. He was intensively treated with lipo PGE₁ and ticlopidine, but his renal function began to deteriorate gradually with HD 144 days after the operation. Although histological diagnoses were not available in the second and third cases, atheromatous embolism was strongly suspected due to an episode of acute embolization, marked LDH elevation, sustained eosinophilia and high-renin hypertension following PTCA or aortic operation. All cases developed acute or chronic renal failure requiring HD, possibly due to intrarenal atheromatous embolism and malignant hypertensive glomerular injury. Strict fibrinolysis or anticoagulation therapy and use of lipo PGE₁ or antiplatelet regimen may contribute to the development and maintenance of atheromatous embolism by unstabilization of previously injured atheromatous plaque surface. Alternatively, primary atheromatous embolism can occur especially among the aged population. Careful follow-up of renal function and examination for atheromatous embolism are recommended in cases of accelerated ASO.

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Drug-induced pure red cell aplasia (PRCA) is rare complication. We report a hemodialyzed patient with carbamazepine-induced PRCA. The patient was a 66-year-old man, maintained on hemodialysis for 17 years. He was admitted to our hospital with complaints of lumbago and gait disturbance due to spinal canal stenosi. Carbamazepine was prescribed, and his symptoms improved. Two months later, progressive anemia ocurred with reticulocyte-counts less than 2‰. Recombinant human erythropoietin (rHuEPO) was not effective for the anemia. Bone marrow smear showed hyoplastic bone marrow with aplasia of erythroid cells. Since drug-induced PRCA was suspected, carbamazepine was stopped. Thereafter, his anemia gradually improved. A few cases of carbamazepine-induced PRCA were previously reported, but to the best of our knowledge, no similar patient receiving dialysis therapy has been reported. PRCA should be considered in hemodialyzed patients with anemia that does not respond to rHuEPO.

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