In 1998, the Japanese Society for Dialysis Therapy conducted a statistical survey of 3, 095 facilities in Japan and received replies from 3, 085 facilities (99.67%). As of the end of 1998, there were 185, 322 dialysis patients in Japan, an increase of 9, 334 patients (5.3%) over a year from the end of 1998. The gross mortality rate was 9.2%, the same as the previous year.
The mean age of the patients who started their dialysis therapy in 1998 was 62.7±13.9 years old (±S. D.). This shows that the age of dialysis patients was higher than the previous year. During the year 1998, the ratio of primary disease among patients beginning dialysis showed for the first time in the present survey that diabetic nephropathy (35.7%) was more common than chronic glomerular nephritis (35.0%).
In the 1998 survey, the type and effectiveness of treatment for dialysis-related amyloidosis, type and obstruction frequency of blood access, life style, activity, transportation method to dialysis center, blood flow rate as well as the kind and flow rate of dialysate were included in the survey questionnaire for the first time.
The prevalence of dialysis-related amyloidosis was 31.0%. The mean blood flow rate of the hemodialysis patients was 189.8ml/min (±36.4 S. D.). Patients commuting to and from dialysis facilities on their own accounted for no more than 61.6% of the overall; 9.8% of patients replied they “were bedridden more than half the day or all day.” Some 82.9% of all of the patients lived at home with their families, and 6.9% lived by themselves. 9.5% of patients were hospitalized. From analysis of the survival prognosis, patients administered Vitamin D₃ had a significantly low death risk. Conversely, patients for whom the product of their predialysis serum calcium and phosphorus concentration was less than 40 or over 70 shown to have a significantly high risk of death.
It was also found that many years on dialysis or a serum intact parathyroid hormone concentration of over 360pg/ml was a risk factor for parathyroidectomy.

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In this prospective trial, 30 patients received Carboflo^® grafts and 30 received Exxcel^® grafts for hemodialysis access between November 1997 and September 1998. The mean age of the patients was 62 years (range: 28-80 years) and the male to female ratio was 28/32. Eighteen patients were diabetic (30%). All grafts were implanted in the forearm, and 21 grafts were antecubital jump bypass grafts. The average follow-up period was 322 days (range: 24-540 days). Gender, age, incidence of diabetes mellitus, duration of dialysis, previous access surgery, and mode of graft placement did not differ between the Carboflo^® group and the Exxcel^® group. Complications were thrombotic occlusion (n=5), outflow venous stenosis (n=7), infection (n=3), seroma (n=1), and steal syndrome (n=1). Primary patency rates were 83.0% at 6 months and 79.0% at 12 months in the Carboflo^® group, and 75.5% at 6 months and 59.9% at 12 months in the Exxcel^® group. Secondary patency rates were 93.1% at 6 and 12 months in the Carboflo^® group and 96.6% at 6 months and 88.5% at 12 months in the Exxcel group. The Carboflo^® graft showed better primary patency than the Exxcel^® graft, but the difference was not significant. Both Carboflo^® and Exxcel^® grafts showed satisfactory patency in the early postoperative period. However, further follow-up studies are needed to correctly evaluate the performance of the Carboflo^® and Exxcel^® grafts.

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Late referral of patients with end stage renal disease (ESRD) has resulted in increased cost, morbidity and even mortality. As the population of ESRD patient increases, it becomes more important to determine when physicians should refer those patients to a nephrologist. In an effort to examine the relationship between referral patterns and therapeutic impact on cost as well as morbidity, we analyzed renal function at the initial visit and on initiating dialysis, status of blood access, and dose of ultrafiltration at the initial dialysis. We also analyzed cost and duration of hospital stay to initiate dialysis for each referral pattern.
From 1994 to 1997, a total of 120 patients entered chronic hemodialysis therapy at this institution and these subjects were divided into three groups. 1) early referral (n=38, 61±14 yrs): referred more than one year before initiation of dialysis 2) intermediate referral (n=41, 62±10 yrs): less than 1 year and more than one month before dialysis 3) late referral (n=41, 60±13 yrs): less than one month before dialysis was initiated.
Mean hospital stay was significantly longer in the late referral group (47 days), and the daily hospital cost for initiating dialysis was higher than those of the early and intermediate groups (late: 46212 yen vs int: 38558 yen, p=.004, late vs early: 37927 yen, p=.005). Already prepared AV fistula was 82% for the early, 90% for the intermediate, 39% for the late referral group. The dose of ultrafiltration at the initial dialysis was 1.18kg for the early, 1.34kg for the intermediate, 2.0kg for the late referral group.
Our results strongly suggest that referral at the earliest opportunity would decrease cost and lower morbidity for ESRD patients.

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[Objective] To clarify the longitudinal changes of values of interleukin-6 (IL-6) in the dialysate, charge selectivity index, and indices of peritoneal equilibration test (PET) for 18 months on average.
[Subjects and method] Thirty peritoneal dialysis patients without episodes of peritonitis for one year prior to the initiation of this study were selected. Following standard PET, two 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 midpoint of the procedure. We measured IL-6 in this 4 hour-dwelled dialysate and glutamate (Glu), glutamine (Gln), lysine (Lys), creatinine (Cr), β₂-microglobulin (β₂-MG), and albumin (Alb) in both drained dialysates (D) and plasma samples (P). Then, the D/P ratio (Cr, β₂-MG and Alb), D/D₀ glucose ratio, and charge selectivity index [CSI (Glu): Glu D/P ratio÷Gln D/P ratio, CSI (Lys): Lys D/P ratio÷Gln D/P ratio] were calculated.
[Results] (1) There were no changes in serum Cr, β₂-MG, or Alb. The D/P ratio of β₂-MG and Alb were also unchanged. (2) The D/P ratio of Cr, IL-6 value in 4 hour-dwelled dialysate, CSI (Glu), and CSI (Lys) increased, and the D/D₀ glucose ratio decreased significantly. (3) Among percent changes of the D/P ratio of Cr, the IL-6 value in 4 hour-dwelled dialysate, CSI (Glu), CSI (Lys), and D/D₀ glucose ratio, IL-6 values have the strongest correlation to the deterioration of peritoneal membrane function.
[Conclusion] The D/P ratio of Cr, IL-6 value in 4 hour-dwelled dialysate, CSI (Glu), CSI (Lys), and D/D₀ glucose ratio showed longitudinal changes for 18 months. Among those parameters, the IL-6 levels reflect deterioration of peritoneal membrane function most significantly.

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During the winter of 1998-1999, many elderly Japanese died from the type A influenza virus. Although no precise reports regarding victims of flu for dialysis patients are available yet, elderly dialysis patients as compromised hosts may have had high mortality. Amantazine hydrochloride (a. h.) is an anti-Parkinsonism medicine that also has anti-Type A influenza action. Because no pharmacokinetics of a. h. in Japanese dialysis patients have been reported yet, we have evaluated the pharmacokinetics of a. h. (100mg/week) in 6 patients. From relatively high blood concentrations following hemodialysis on days 3 and 7, we speculated that the dose should be adjusted to less than 100mg/week or the interval of administration to more than one week.

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Recent studies suggest that calcium-sensing receptors (CaSR) play a crucial role in the regulation of parathyroid hormone (PTH) secretion and may also have some association with parathyroid cell proliferation. To investigate the possible involvement of CaSR as well as vitamin D receptor (VDR) in the regulation of parathyroid cell proliferation, we performed the immunohistochemical examination using sections obtained from a patient with severe secondary hyperparathyroidism.
A 34-year-old man on maintenance hemodialysis caused by chronic glomerular nephritis was referred to us for the control of severe secondary hyperparathyroidism. He suffered from severe bone pain and arthralgia. Corrected serum Ca was 10.9mg/dl, intact PTH 3500pg/ml and serum levels of biochemical bone markers markedly high (ALP: 13729IU/L, osteocalcin: 3140ng/ml, TRAP: 44.0IU/L). Oral vitamin D pulse therapy was not effective. In 1997, total parathyroidectomy with autotransplantation was performed. Postoperatively, his clinical symptoms, severe anemia and radiographic findings were dramatically improved.
Total weight of the four parathyroid glands was 2.5g and the histological examination revealed diffuse hyperplasia with nodular formation. Using formalin fixed paraffin embedded sections, immunohistochemical staining was examined with specific antibodies against VDR, CaSR and Ki 67 as a marker of cell proliferative activity. The immunoreactive expressions of VDR and CaSR were much lower in parathyroid from this patient than in those from control. Parathyroid cells from this patient possessed high proliferative activity, especially in the nodular area. Not only VDR but also CaSR expressions were more clearly decreased in the more highly proliferative lesion.
The pathological state caused by a markedly elevated PTH level would be associated with reduced expressions of VDR as well as CaSR, resulting in increased proliferative activity of parathyroid cells.

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A 36-year-old male patient with chronic renal failure complicated by chronic hepatitis C had been on maintenance hemodialysis since September 1993. He was admitted to our hospital to receive interferon (IFN) therapy for HCV infection prior to living donor-related renal transplantation. The concentration of HCV-RNA in serum was 8.4 Meq/ml by branched DNA assay, HCV genotype was 2a. IFN-β was chosen for treatment because not only IFN-β could be administered intravenously through the blood access for hemodialysis but also the half-life of IFN-β was short. To evaluate changes in the IFN-β concentration, 600 MIU IFN-β was preliminary infused for 3 minutes. The serum concentration of IFN-β raised up to 25600IU/ml and hypotension was appeared. Thus, we considered that drip infusion for 60 min was reasonable in this case. By drip infusion, the IFN-β concentration was not so high. After discharge, his headache worsened. So, IFN-β administration was stopped on day 71 due to neurological side effects. After IFN-β treatment ceased, HCV-RNA became positive again. Renal transplantation was performed 9 months later, and. liver dysfunction had not developed. In hemodialysis patients as well as others, IFN-β treatment by drip infusion is considered an acceptable method of achieving an appropriate concentration. However, in our case, IFN-β treatment was stopped due to its side effect, and so we must be more careful in administering IFN-β therapy to hemodialysis patients.

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