Twenty-four hours ambulatory electrocardiographic study was performed in 89 patients on maintenance hemodialysis. Electrocardiographic monitoring revealed supraventricular premature contraction (SVPC) in 81 patients (91%), ventricular premature contraction (VPC) in 83 patients (93.3%), atrioventricular block (A-V block) in 19 patients, sick sinus syndrome (SSS) in 6 patients, and ventricular tachycardia (VT) in 8 patients. The patients were classified into three groups according to the numbers of recorded arrhythmias, namely the normal, sporadic, or frequent group. In patients with frequent SVPC, the age was significantly older and the left atrial dimmension were significantly enlarged. In patients with frequent VPC, the ejection fraction was significantly decreased, and the left ventricular dimension was significantly enlarged. Patients with VT had a higher incidence of complication by cardiovascular disease and diabetes mellitus. The administration of antiarrhythmic agents in 25 patients with VPC decreased the frequency of VPC in 9 patients (36%), had no effect or worsened in 16 patients (64%). Two patients classified as worsened progressed to arrhythmogenic death. In patients with worsened group, the ejection fraction was significantly decreased, and the left ventricular dimension was significantly enlarged. These results lead us to conclude that arrhythmias in patients on maintenance hemodialysis are an important indication to investigate underlined cardiovascular disease, impaired cardiac function, and left ventricular dilatation.

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We examined the effect of angiotensin II (A II) on membrane permeability during peritoneal dialysis in the rat. We established an A II-dependent hypertension rat model (a 2 kidney 1 clip model). Male Sprague-Dawley (S. D.) rats with normal kidney function and weighing approximately 300g were administered 0.25mmol A II for 2 weeks through a mini-osmotic pump implanted either subcutaneously or into the peritoneal cavity. The rats were then dialyzed by infusing 30ml of hypertonic dialysate (dextrose concentration: 3.86%) and then allowing it to remain for 4 hours. The peritoneal net fluid absorption rate (PNFAR) did not significantly increase, but both the albumin loss and glucose absorption significantly decreased after the administration of A II either subcutaneously or into the abdominal cavity, in comparison to the findings in the control group. The A II-dependent hypertension rats did not demonstrate any significant changes in the parameters when compared with those in the control group. In conclusion, these findings suggest that A II decreases membrane permeability during peritoneal dialysis in the rat.

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To evaluate the change in parathyroid function during long-term hemodialysis, c-PTH and other related parameters were evaluated in 38 stable patients receiving maintenance hemodialysis for more than 10 years. At the start of hemodialysis, there was a significant negative correlation between c-PTH level and age (p<0.05), and c-PTH level was lower in elderly patients. Patients showing a c-PTH level more than 10ng/ml were judged to be advanced hyperparathyroidism. Based on this criteria, 17 of 38 (44.7%) patients developed hyperparathyroidism during the 10-year follow-up. Factors that affected the occurrence of hyperparathyroidism were analyzed. It was revealed that the incidence of hyperparathyroidism were significantly less in patients with higher serum calcium levels (≥9.0mg/dl) than in those with lower serum calcium levels (<9.0mg/dl). In patients treated with vitamin D for more than 60% of their total dialysis treatment terms, the incidence of hyperparathyroidism was significantly less compared to those with less than 60% (p<0.0005). There was a significant positive correlation between the duration of vitamin D treatment and the serum calcium level (p<0.005). Meanwhile, there was no significant correlation between the occurrence of hyperparathyroidism and the serum inorganic phosphorus level.
These results suggest that the longer the duration of hemodialysis, the higher the c-PTH level in most patients, and the risk of developing hyperparathyroidism is inevitable. To prevent this complication, we recommend the maintaining serum calcium level to be more than 9.0mg/dl with vitamin D supplementation.

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Infrared absorption spectra of several kinds of HD membranes before and after HD treatment were obtained by Fournier transform infrared (FTIR) spectroscopy fitted with an attenuated total reflection (ATR) attachment with Ge reflection elements in order to analyze the external membrane surface.
For cases of cuproammonium rayon membrane and modified cellulose membranes such as DEAE and Vit. E-coated cellulose membrane, two new bands assigned to C=O stretching vibration mode (amide I band) and N-H deforming vibration mode (amide II band) were observed after use, indicating adsorption of proteins on the membrane surface. For PEG-coated modified cellulose membrane, there was no change in the spectrum after use. For cellulose triacetate membrane, C=O strecthing vibration band assigned to acetyl groups of the membrane shifted to a lower wavenumber after use, indicating chemical adsorption of proteins on the acetyl groups of membrane.
The FTIR-ATR method is one of the methods of analyzing the external membrane surface.

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We report the successful management of dry weight in a pregnant woman requiring hemodialysis by noninvasive examination (diameter of inferior vena cava by ultrasound sonography, human natriuretic peptide (hANP), and continuous hematocrit monitoring (CRIT-LINE®)).
The patient was a 28-year old woman with a clinical history of hemodialysis for 6 years. She was admitted to our hospital at 8 weeks of gestation for management of hypertension and hemodialysis.
In setting her dry weight, we estimated the value by noninvasive examination. Her hospital course, including hemodialysis, was stable until 20 weeks of gestation. Although adequate hemodialysis and an appropriate dry weight were set, polyhydroamnious developed at 21 weeks of gestation. Thereafter, her blood pressure was extremely high. She finally delivered a baby weighing 836g by caesarian section at 28 weeks of gestation.
We conclude that setting the dry weight by noninvasive method, without complication for either the mother or fetus, is useful for maintaining a pregnant patient.

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We describe 3 cases of hemodialysis patients with spontaneous rupture of acquired cystic kidney disease (ACDK). All patients suddenly complained of colicky flank pain. Computed tomography (CT) demonstrated bulky hematoma with swollen ACDK. Blood examination showed progressing anemia and hyperkalemia. We transfused a total of 800ml packed cells to the first case, 1000ml to the second case and 1200ml to the third case. Simultaneously hemodialysis was performed using nafamostat mesilate to improve hyperkalemia. After these treatment, anemia and hyperkalemia were corrected, and the patients' symptom disappeared. A few months later CT showed that the hematoma had been absorbed.

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