To assess the prevalence and determinants of cardiac dysfunction in hemodialysis patients, M-mode and Doppler echocardiography were performed in 130 patients (79 male and 51 female; mean age, 59.8 years; mean time on chronic dialysis, 9.6 years; diabetes 31 patients). Left ventricular (LV) hypertrophy was observed in 102 patients (78%) and the associated risk factor was systolic hypertension. LV cavity size rarely enlarged (3.8%) without a predictor. LV systolic dysfunction was found in 13 patients (10%) and interdialytic weight gain and ischemic heart disease were the determinants. LV diastolic function was abnormal in 43% and was associated with older age. These results suggest that LV abnormalities, which are common in patients on chronic hemodialysis, are associated with hypertension, interdialytic weight gain, ischemic heart disease and older age. Therefore, good blood pressure control and adequate nutrition management, including water and salt restriction, are likely important in hemodialysis patients due to a high prevalence of cardiac death.

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Objective: To clarify whether interleukin-6 (IL-6) in peritoneal dialysate is a useful index of peritoneal function, we analysed the relationship between the level of IL-6 in a 4-hour dwelled dialysate and indices of the standard 4-hour peritoneal equilibration test.
Subjects and method: The subjects were 40 peritoneal dialysis patients without episodes of peritonitis for 1 year prior to the initiation of this study. Following the standard peritoneal equilibration test (PET), 2 liters of 2.5% glucose dialysate was dwelled in the peritoneal cavity for exactly 4 hours. Dialysate samples were collected at 0 and 4 hours. A single serum sample was obtained at the mid point of the procedure. IL-6 in this 4-hour dwelled dialysate was measured.
Peritoneal transport was estimated using the dialysate (D) to plasma (P) ratio of creatinine (Cr), β₂-microglobulin (β₂-MG) and albumin (Alb) at 4 hours. The D/D₀ glucose ratio was calculated.
Result: (1) The value of IL-6 in the 4-hour dwelled dialysate was 54.43±38.02 (m.±SD) pg/ml. (2) The relationships among IL-6 values and the other indices were; D/D₀ glucose ratio (R=-0.803, p.<0.001), D/P Cr ratio (R=0.773, p.<0.001), D/P β₂-MG ratio (R=0.594, p.<0.01), D/P Alb ratio (R=0, 468, p.<0.05). The strongest correlation was found between IL-6 and the D/D₀ glucose ratio. (3) A clear correlation was also found between IL-6 values in the 4-hour dwelled dialysate and peritoneal dialysis duration (R=0.797, p.<0.001).
Conclusion: The IL-6 value in 4-hour dwelled dialysate can be considered a possible new index to assess peritoneal membrane function.

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This study was conducted to identify the minimum exercise intensity level required to detect a reliable oxygen uptake efficiency slope (OUES) in patients with chronic hemodialysis (HD). Sixty seven HD patients and 66 clinically healthy subjects (controls) performed an incremental maximal exercise test with modified Bruce's protocol. In all subjects, maximal oxygen uptake (VO₂max), OUES at 8 exercise intensity levels (30-100%HR reserve) was measured. OUES was derived from the relationship between oxygen uptake (VO₂) and minute ventilation (VE) during the incremental maximal exercise test and was determined by VO₂=a×logVE+b, (a=OUES). VO₂max in HD patients and controls was 1320.9±298.7 and 2109.4±607.5 ml/min, respectively. Maximal exercise intensity OUES in HD patients and controls was 1474.8±360.1 and 2265.3±633.0, respectively. The maximal exercise intensity OUES and VO₂max were significantly correlated in HD patients (r=0.903, p<0.001) and controls (r=0.910, p<0.001). Although high correlation coefficients (over 0.90) of the logarithmic curve-fitting model between VO₂ and VE during incremental exercise were recognized at exercise intensity above 50%HR reserve in controls, they were recognized at all exercise intensity levels in HD patients. Although the mean value of OUES at the submaximal exercise intensity decreased with lower exercise intensity in controls, it increased with lower exercise intensity in HD patients. The reliability coefficients between maximal exercise intensity OUES and a submaximal level of exercise intensity OUES were high (α>0.90), above 60%HR reserve in controls. However, the reliability coefficients were high at 50%HR reserve in HD patients, In conclusion, our findings suggest that an exercise intensity level of 50%HR reserve is required to detect reliable OUES in HD patients.

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We report here, two hemodialysis patients associated with Laurence-Moon-Biedl syndrome (LMBS). LMBS is characterized by retinitis pigmentosa, polydactyly, hypogenitalism, obesity and mental retardation. However, a wide range of additional signs occur and renal abnormalities have been frequently encountered. Uremia is the most common cause of death in LMBS. Therefore, LMBS must be considered in the differential diagnoses for underlying diseases in hemodialysis patients.

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Vascular access remains a major problem in hemodialysis for small children, especially in those weighing less than 15kg. We describe our results using a double-lumen, silicon rubber, indwelling central venous catheter with a subcutaneous Dacron cuff (Hickman catheter^®) as blood access for hemodialysis. The age of four patients ranged from 15 to 84 months, weighing from 7.8 to 13.8kg at the time when dialysis was started in our institute. Their indications for hemodialysis included frequent peritonitis, post-living-related liver transplantation, postaugmentation cystoplasty and low peritoneal capacity due to polycystic kidney. Serious catheter complications were rarely recognized. In one patient with long-term dialysis, one episode of systemic catheter infection occurred. The Kt/V values ranged from 1.06 to 1.41. In all cases, each port was filled with 1000 U/ml heparin sodium and a low dose of aspirin was administered to one patient with no coagulative obstruction.

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A 51-year-old female on maintenance hemodialysis due to polycystic kidney disease, was admitted to our hospital due to massive ascites. Clinical examination revealed moderately positive Mantoux reaction; exudative findings of peritoneal and pleural effusions with a dominant lymphocyte count and elevated adenosine deaminase levels; hypercalcemia 10.7mg/dl; low level of i-PTH, 21.0pg/ml; and upper normal 1, 25 Vit. D level, 54.4pg/ml. After starting antituberculous therapy with Isoniazide, Rifampicin and Ethambutol, peritoneal and pleural effusions disappeared. Furthermore, the serum calcium level decreased rapidly to 5.6mg/dl, i-PTH increased to 135pg/ml and 1, 25 Vit. D decreased to 21.0pg/ml, consistent with chronic renal failure. The present findings suggested that the ectopic production of 1, 25 Vit. D due to tuberculosis caused both hypercalcemia and suppression of i-PTH. We concluded that tuberculosis is an important cause of ascites and pleural effusion in hemodialysis patients, and that abnormal Ca metabolism, if presented, indicates tuberculosis.

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We reported a case of retroperitoneal fibrosis with acute renal failure. The patient was a 71-year-old male with hypertension controlled by 1 agent, doxazosin mesilate. A second agent, Esidri^®, which is a mixture of hydralazine, hydrochlorothiazide and reserpine, was added to his antihypertensive regimen from February 18 to March 17, and from May 9 to May 16. He was admitted to our hospital for lower back pain and anuria on May 18. Ultrasonography showed slight hydronephrosis. Diuretics were not effective. Doxazosin mesilate and Esidri^® were discontinued. Due to severe hypoxemia and metabolic acidosis, hemodialysis was started. Computed tomography (CT) demonstrated a soft tissue mass around the abdominal aorta. The mass showed low signal intensity on both T 1 and T 2 weighted images of magnetic reasonance imaging (MRI), suggesting fibrous components. No malignancy was detected by gastrointestinal fiberscopy or gallium scintigraphy. Anti-nuclear

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