The present condition of the hospital infection and infection control in hemodialysis (HD) therapy was investigated.
We mailed questionnaire to 2910 hemodialysis facilities in Japan and recovered them from 1681 facilities (57.8%). The recoveries from private facilities were lower (44.8%) than those from other facilities (51.7%). There were no differences by region or facility scale. 81.6% of facilities had made their infection control manual, and the infection control committees were founded at the 74.5% of facilities. The 2/3 of facilities opened infection control committee every month. HBs antigen and HCV antibody were measured in 93.3% and 98.4%, and were positive in 2.84% and 22.4% of patients, respectively. HBs antigen and HCV antibody positive rate were different between 7 regions (p=0.00515, p<0.0001) and between founders (p<0.0001, p<0.0001). HBs antigen and HCV antibody positive rate of facilities showed positive correlation with dialysis period (p=0.00308, p<0.0001). There was a weak correlation between HBs antigen positive rate and HCV antibody positive rate of facilities (r=.145, p<0.0001). Meantime, HB vaccination was carried out only in 24.3% of facilities, room isolation of HBs antigen positive patient in 1.88%, and bed fixation in 59.0% facilities. In the HCV antibody positive patients, room isolation was done in 0.674%, and bed fixation in 43.2%. Some facilities reported reuse of syringes for drug administration (2.06%), reuse of leftover isotonic sodium chloride solution, and divided dosage (5.54%) of erythropoietin ample. The daily attention for HBs antigen positive patients, bed fixation, notification, and daily life consultation for the HCV antibody positive patient were considered to be mandatory.
We conclude that hemodialysis patients were suffered from viral hepatitis, and the infection control measures were mandatory. Prospective study on the risk of the hospital infection control and investigation on the precaution will be further necessary.

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A multicenter collaborative study examined the usefulness of serum transferrin receptors (sTfR) as an index of iron deficiency in hemodialysis (HD) patients receiving recombinant human erythropoietin (rHuEpo).
The subjects were 80 maintenance HD patients administered rHuEpo who had not changed their dose rHuEpo or taken an iron preparation for at least the past 3 months, and who had no complications including other types of cytopenia, inflammatory diseases, hemolytic diseases, severe hyperparathyroidism or hepatic dysfunction. These patients were diagnosed with iron deficiency and administered an iron preparation intravenously. Hematology, iron kinetics and blood chemistry tests were performed and sTfR values were measured before and after administration. The effects of the iron preparation were evaluated using ΔHt, the difference between the Ht value before iron preparation administration and the maximal Ht value after 2 to 8 weeks of the administration. When ΔHt was 3% or higher, the iron preparation was considered effective and when it was less than 3%, the treatment considered was ineffective.
The effective cases (n=43) showed significantly higher sTfR values (1078±253 vs 917±241 ng/ml, p<0.005) and sTfR/Hb values (11.1±3.2 vs 8.8±2.2, μg/g, p<0.0005), and significantly lower serum ferritin (sFt) values (58±25 vs 82±36ng/ml, p<0.001) than the ineffective cases (n=37). However, the transferrin iron saturation rate (Fe-Sat), the reticulocyte count and the reticulocyte percentage did not show any differences. The ΔHt value showed better correlation with the sTfR/Hb values (r=0.672) than the sTfR, sFt and Fe-Sat values.
The diagnostic success rate for iron deficiency was the highest, 67.5% for sTfR/Hb (cut-off value: 10μg/g), followed by sTfR (1000ng/ml), sFt (50ng/ml), sFt (100ng/ml) and Fe-Sat (20%).
In conclusion, the sTfR/Hb value was considered to be the most useful index for diagnosing the necessity of administering an iron preparation to treat iron deficiency in HD patients receiving rHuEpo.

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The effect of the prophylactic use of intranasal mupirocin ointment on the incidence of exit site infection in peritoneal dialysis patients was prospectively evaluated. Staphylococci were observed in the nares of 21 patients and this group was treated with 2% mupirocin nasal ointment three times a day for 7 days every other month for a year. Staphylococcal exit site infection rate was 0.57/patient/year with mupirocin treatment, which was significantly lower than that for the previous 1 year (1.10/patient/year, p<0.01). However, mupirocin therapy could completely eradicate Staphylococci from the nares in only 13 (responder) of 21 patients. Compliance with treatment was evaluated monthly, revealing that 8 patients had not applied the ointment to the nares more than 70% of the prescribed times. During the 1-year treatment, exit site infection occured only one time in 13 responders, while it occured 11 times in 5 of 8 patients with poor compliance (p<0.01).
In conclusion, prophylactic therapy using intranasal mupirocin was effective on lowering the incidence of exit site infection. However, periodic examination of compliance and recolonization after treatment is essential to obtain solid evidence.

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Purpose: We analyzed the effect of postural change from standing to supine position on hematocrit (Ht), plasma protein concentration (TP) and circulating blood volume in chronic hemodialyzed patients. Methods: In male HD patients (n=10), Ht and TP were measured after 5 minutes standing and 30 minutes supine. The percent change in blood volume (%ΔBV) was calculated by the change of Ht and TP. Results: 1) During 30 minutes supine, Ht and TP fell in all cases from 32.6±2.1%, 6.68±0.12g/dl to 29.7±1.9%, 5.81±0.10g/dl. 2) %ΔBV increased by 9.1±0.8% during 30 minutes supine. These changes were significantly larger than those in healthy subjects. Conclusions: When evaluating Ht, TP and %ΔBV, it is important to consider the influence of postural change especially in chronically hemodialyzed patients.

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We present a case of probable toxic shock-like syndrome (TSLS). A 33-year-old man who had received hemodialysis for three years was admitted to our hospital for evaluation and treatment of fever, generalized erythema and shock. Because laboratory findings exhibited suspected DIC, elevation of serum bilirubin, and decreased arterial PO₂ suggestive of impending multiorgan failure due to sepsis, direct hemoperfusion with polymixin B-immobilized column was performed on the day of admission. However, there was no effect. Because of sustained shock, plasma exchange (PE) was performed, promoting prompt recovery from hypotension one hour after the initiation of PE. Thereafter, the patient improved in generalized condition and was discharged after three weeks.

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A 54-year-old male patient, receiving maintenance hemodialysis for 8 years, is reported. Acquired cystic disease of the kidney (ACDK) had already been detected by routine abdominal imaging procedures. The patient complained of severe left flank pain and was admitted to our hospital. CT scanning revealed massive left perinephric hematoma. We performed transcatheter arterial embolization of the left renal artery but there was no renal tumor detected by abdominal imaging procedures, such as angiography, CT and MRI. The posttreatment course was uneventful and the patient continues to be maintained on hemodialysis.

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This report documents a successfully treated pediatric peritoneal dialysis patient with refractory fungal peritonitis. The patient was an 8-year-old girl with a 3.3-year history of peritoneal dialysis. She developed fungal peritonitis which was identified as Aspergillus (Neosartorya) fennelliae by PCR of fungal rRNA, and was complicated by jejunum perforation during the clinical course.
Comprehensive treatment including 1) early removal of CAPD catheter, 2) use of liposomal Amphotericin B (AMPH-B) which is less infusion-related toxicity and can be administered at a higher dose than conventional AMPH-B, 3) use of Itraconazole oral solution which can be administered from jejunostomy because it act without gastric acid, 4) appropriate nutritional support (intravenous hyperalimentation with enteral nutrition from jejunostomy), all seemed to contribute to the recovery of our patient.
Although uncommon, fungal peritonitis remains a serious problem in patients undergoing peritoneal dialysis. This report may provide evidence for the usefulness of liposomal AMPH-B on the therapy for peritoneal dialysis patients with Aspergillus peritonitis.

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