Serial changes in bone mineral density (BMD) were compared among ∑GS/D and radial BMD was evaluated by CXD (rBMD-CXD) and DXA (rBMD-DXA), and lumbar and cranial BMD by DXA for 24 months in 53 regular HD patients.
Both male and female patients demonstrated a significant decrease in rBMD-CXD after 12 months, whereas only female patients with high PTH (intact-PTH≥160pg/ml) showed decreases in ∑GS/D and rBMD-DXA. Although the decrease in BMD was greater in the high PTH group than in the low PTH group (intact PTH<160pg/ml) regardless of the evaluating method of BMD, the reduction of rBMD-CXD was significantly greater than that of rBMD-DXA during the observation period in both male and female groups. Inverse correlations of BMD to age or the HD period were only observed between rBMD-CXD and the HD period.
rBMD-CXD was closely correlated not only to cortical bones such as rBMD-DXA and arms, but also to whole body BMD. In females, rBMD-CXD was also closely correlated to lumbar BMD independent of the PTH levels. These results suggest that rBMD-CXD can detect radial BMD loss more sensitively than rBMD-DXA and ∑GS/D, possibly because it may reflect both cortical and trabecular bone loss of HD patients.

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Magnesium (Mg) metabolism plays an important role in the pathogenesis of hypertension, lipid abnormalities and cardiovascular diseases such as ischemic heart disease and arrhythmia. Therefore, we investigated whether Mg metabolism was associated with serum lipids, atherosclerosis and ischemic heart disease (IHD) in 314 chronic hemodialysis patients (250 non-diabetes and 64 diabetes).
The serum levels of total Mg and blood ionized Mg measured before hemodialysis were significantly higher in patients than in age-matched control subjects, and those in the diabetes group were significantly lower than those in the non-diabetes group.
The ionized Mg level was significantly correlated to the HDL-cholesterol level positively and with the atherosclerotic index (AI) negatively. The incidence of aortic calcification (AoC) on chest X-ray in the diabetes group was significantly higher than that in the non-diabetes group, and in both groups, the ionized Mg level in patients with AoC was significantly lower than that in patients without AoC. The aortic calcification index (ACI) evaluated by abdominal CT in the diabetes group was significantly higher than that in the non-diabetes group, and in both groups, the ACI was significantly correlated with AI positively and with ionized Mg level negatively. The incidence of IHD in the diabetes group was significantly higher than that in the non-diabetes group, and in the diabetes group, the ionized Mg level in patients with IHD was significantly lower than that in patients without IHD.
These results suggest that in chronic hemodialysis patients, particularly in diabetes patients, abnormalities of Mg metabolism such as a decrease in the blood ionized Mg level may contribute to the pathogenesis of lipid abnormalities, atherosclerosis and ischemic heart disease.

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We examined nasal and throat carriage of bacteria in outpatients receiving maintenance hemodialysis therapy, twice a year since 1995. Enteric gram-negative rods were detected in 25% of the patients. Klebsiella spp. were the most frequent, detected in 10.5% of the patients. Pseudomonas aeruginosa was detected in 4.6%. These frequencies were 2 times higher than data from outpatients excluding end-stage renal disease. In 36% with Klebsiella spp. and 17% with P. aeruginosa, the bacteria were considered constant flora in the upper respiratory area by sequential observation. In the winter season, the detection rate of Pseudomonas spp, Serratia spp and Acinetobactor spp was higher than in the summer. These data suggested that Klebsiella spp. and P. aeruginosa were the most severe bacteria for indigenous infectious disease in outpatients receiving maintenance hemodialysis therapy.

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The periodic structure of 24-hour blood pressure variation (circadian rhythm of blood pressure by ambulatory blood pressure monitoring (ABPM)) in hypertensive patients on hemodialysis was investigated by a new technique, the maximum entropy spectral method. This method allows the effectiveness of antihypertensive therapies to be evaluated in such patients. The results were as follows; 1) The percentage of non-dipper type hypertension was 75% (15/20), and the remaining 25% (5/20) showed dipper type hypertension. A rise in morning blood pressure (morning surge) was noted in 60% of the former group and in 80% of the latter group. 2) Night time systolic blood pressure (180±19mmHg) was higher in patients with non-dipper type hypertension than in those with dipper type (146±17mmHg, n=8, p<0.01). 3) The standardized level of blood pressure (SLBP) in patients with non-dipper type hypertension (174±15mmHg) was significantly higher than that in those with dipper type (154±18mmHg, n=8, p<0.05). 4) Treatment with a Ca antagonist alone significantly reduced both SLBP and the area over the SLBP (SLBP; from 182±16mmHg to 167±10mmHg (p<0.05, n=8), and area over the SLBP; from 2380±480 to 2164±326 (p<0.05, n=8)). 5) Addition of an α₁-blocker to the current treatment with a Ca antagonist was significantly efficacious in deducing the rise in morning blood pressure (morning surge).
This study using ABPM suggests that the blood pressure of hypertensive hemodialyzed patients is characterized by a non-dipper type dominance and a frequent morning surge. Furthermore, combined therapy with a Ca antagonist and α₁-blocker was markedly effective both in reducing the overall blood pressure level and in inhibiting the morning surge.

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It has recently been reported that CRIT-LINE accurately measures the condition of the levels of body fluid. However, in patients showing inability to shift body fluid from the interstitium into blood vessles, excess body fluid may remain. Considering that body composition between the intra and extracellular space varies during hemodialysis, we proposed that not only CRIT-LINE but also the body composition analyzer are required for an accurate estimation of body fluid. We found that the ratio of intracellular fluid to extracellular fluid (I/E ratio) decreased and detected a significantly negative correlation with age (I/E=-0.016×age+1.94; r=0.75, p<0.01). By examining the condition of body fluid using both CRIT-LINE and the body composition analyzer, we concluded that CRIT-LINE monitoring alone is not sufficient to estimate the body fluid level in patients with heart failure or hypoalbuminuria due to liver cirrhosis or diabetic nephropathy.

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Recently, measurements of the inferior vena cava diameter have been found to be useful in the assessment of the precise dry weight in hemodialysis (HD) patients. We measured the maximal diameter of the IVC at expiration (IVC-E), the minimal diameter at inspiration (IVC-I) and the collapsibility index (CI:(IVC-E-IVC-I)/IVC-E) in 50 patients with chronic renal failure undergoing hemodialysis who had no clinical signs of cardiac or respiratory failure. In addition, serum levels of h-ANP were measured.
No significant correlation was found between the percent changes in body weight (ΔBW%: (pre HD BW-post HD BW)/post HD BW) and percent changes in h-ANP (Δh-ANP%: (pre HD h-ANP-post HD h-ANP)/post HD h-ANP).
The mean IVC-E before HD was significantly correlated with the mean h-ANP level before HD (r=0.57, p<0.001), but no significant correlation was found between the mean IVC-E and the mean h-ANP level after HD.
ΔBW% were significantly correlated with the percent changes in IVC-E before and after hemodialysis (r=0.75, p<0.001).
In analysis limited to diabetic patients (n=15), each study concerned with CI and IVC-E showed results identical to those found in overall cases. These findings suggest that evaluation of IVC-E by ultrasonic procedures is a reliable indicator to determine the dry weight in hemodialyzed patients including diabetic patients, particularly in those with excess dehydration.

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Patients with ascites often develop spontaneous bacterial peritonitis (SBP) even if no focus for infection is present. To investigate the frequency of SBP in CAPD patients, we studied the causes of 76 episodes of consecutive peritonitis in 40 patients between 1994 and 1997. SBP was diagnosed if the peritonitis occurred in patients using a sterile connection device without manipulation errors, exit site/skin tunnel infections and cracks in dialysate bags or tubes. Of all 76 peritonitis episodes, 28 (36, 8%) cases were caused from touch contamination and 14 (18.4%) cases were due to exit site/skin tunnel infections, whereas 34 (44.7%) cases were diagnosed as SBP. The most frequently cultured bacteria in SBP were Streptococcus, E. coli and Klebsiella. SBP can not be prevented by improving connection devices and remains an unsolved problem in peritoneal dialysis.

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