Even a few years after the initiation of hemodialysis therapy, some patients are known to keep their residual renal function. We tried to clarify the impact of residual renal function on the evaluation of both dialysis adequacy and nutritional status in maintenance hemodialysis patients. Among 56 of maintenance hemodialysis patients at the Dialysis Center of Chiba Nishi General Hospital, 10 of 21 anuric patients (group I) and 8 of 21 patients who had preserved their residual renal function (urine volume>500ml/day; group II) were included in this study. Kt/V and the (TAC) urea, calculated from the standard equation, were not different between group I and II (1.50±0.10 vs. 1.35±0.11, 44.2±2.25mg/dl vs. 42.5±1.95mg/dl, respectively). PCR, calculated without consideration of residual renal function, was significantly lower in group II (1.0±0.05 vs. 0.83±0.05g/day/kg, p<0.05). PCR calculated from urine chemistry {(PCR) ur} in group II was 0.25±0.02g/day/kg, which increased Total PCR {PCR+(PCR) ur} to 1.08±0.04g/day/kg in group II. Eventually Total PCR in group II was not significantly different from the PCR in group I. The daily protein intake calculated from dietrecord was more related to Total PCR rather than PCR (r: 0.57 vs. 0.01) in 13 patients who had more than 500ml/day of urine volume. Hence, the residual renal function should be taken into consideration in evaluating the nutritional status in maintenance hemodialysis patients with an unnegligible amount of urine volume.

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Objectives: To clarify the clinicopathological features of renal cancer (RCC) occurring in chronic hemodialysis patients, including those with acquired cystic disease of the kidney (ACDK), we analyzed patient demographics, hemodialysis duration, pathological characteristics of the tumors, and prognoses of the patients.
Methods: A total of 507 hospitals provided information regarding clinicopathological results of 223 patients with renal cysts associated with RCC who had already undergone nephrectomy. Among them, we analyzed the characteristics of 71 cases, including 62 patients with ACDK (1.08% of the total of 5721 RCC patients collected) who underwent maintenance hemodialysis. In addition, 33 patients with RCC who had normal kidney function and were treated in our hospital were used as control subjects.
Results: ACDK with RCC accounted for 83% of the hemodialysis patients with RCC. Fifty-five% of the ACDK patients with RCC had pT2 tumors, but only 1.7% showed distant metastases. A cause-specific 5-year survival rate in the ACDK patients was significantly higher than that in the control subjects. Studies on morphology of RCC in the ACDK patients revealed that alveolar type, tubular type, and papillary type accounted for 48.3%, 13.1%, and 21.3% of their histologic patterns, respectively, and that 57.4% of the patients had clear cell subtype and 21.3% had granular subtype. Incidences of granular cell subtype as well as tubular (p<0.04) or papillary type (p<0.02) were higher in the ACDK patients than that in the control subjects. In 69 patients with either ACDK or other renal cystic diseases, there was a growing tendency for the patients with long-term hemodialysis (longer than 10 years) to increase the incidence of these histological types.

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To elucidate whether ankle pressure index (API) and transcutaneous PO₂ (TCPO₂) are useful for the diagnosis of arteriosclerosis obliterans (ASO) in hemodialysis (HD) patients, 320 HD patients were divided by Fontaine classification, and API and TCPO₂ were measured. In patients showing clinical symptoms>Fontaine II, lower extremity arteriography and treadmill exercise test were also performed.
Sixty-six (20.6%) patients had clinical symptoms>Fontaine II. The number of HD patients with normal API value (0.9-1.2), borderline API value (0.7-0.9 or>1.2) and abnormal API value (<0.7 or impossible measurement) were 148 (46.3%), 125 (39.1%) and 47 (14.7%), respectively. Clinical symptoms>Fontaine II were more frequently found in the patients with abnormal API value (23/47, 48.9%) and borderline API value (27/125, 21.6%) than in the patients with normal API value (16/148, 10.8%). Incidence of lower extremity artery stenosis (narrowed>75%) was significantly higher in the patients with abnormal API value (20/22, 90.9%) and the patients with API value>1.2 (8/10, 80.0%) than in the patients with normal API value (6/16, 37.5%). TCPO₂ level was significantly lower in the patients of Fontaine III (35±22mmHg) than in the patients of Fontaine II (47±18mmHg). Although TCPO₂ levels in the patients of Fontaine II were comparable to those of Fontaine I (50±14mmHg), TCPO₂ level was more significantly reduced by treadmill exercise in the patients of Fontaine II (Δ18±16mmHg) than in those of Fontaine I (Δ4±12mmHg).
These results suggest that API and TCPO₂ are useful diagnostic indices of ASO in HD patients, but that clinical symptoms>Fontaine II and lower extremity artery stenosis were frequently observed in HD patients with normal API value. Therefore, the diagnosis of ASO must be assessed using both indices for HD patients.

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Background and objectives: Flavonoids have been reported to increase the blood level of some drugs excreted by the liver. Since amezinium metilsulfate (AM) is metabolized and excreted by the liver, there is a possibility that flavonoids would increase or maintain AM levels in patients' blood. Thus, the authors administered to patients AM with grapefruit juice (GF juice), which contains a large amount of flavonoids, or AM with water, to compare blood pressure between the two forms of administration during hemodialysis (HD).
Methods: Ten chronic HD patients were given 10mg of AM together with 100ml of 100% GF juice at the beginning of HD, and in the next week, the same patients were also given 10mg of AM together with 100ml of water at the beginning of HD. At every hour during HD, the percentage of the mean blood pressure relative to that at the start (% mean blood pressure) was compared between both types of administration of AM.
Results: By the 3 rd hour of HD treatment, no significant differences were found between the AM/GF juice form of administration and the AM/water form of administration. However, at the 4 th hour of HD, the % mean blood pressure was significantly higher (p<0.005) with the AM/GF juice form of administration than with the AM/water form of administration.
Conclusion: GF juice enhances the AM action to prevent blood pressure drop during HD.

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This study was undertaken to examine the correlation between degree of pruritus of hemodialysis patients and the quantity of dialyzer rinsing solution. In study 1, 15 patients undergoing dialysis treatment were examined regarding the severity of pruritus. The monthly total dose of antipruritic drugs (Glycyrrhizin, Neurotropin and Ketotifen fumarate) needed to treat the pruritus was measured under the use of 1500ml of rinsing solution. The patients were then compared with those under the use of 2000ml of rinsing solution. As a control group, 5 non-pruritic patients were also studied. Pruritus vanished in 7 patients, diminished in 5 and did not change in 3. Furthermore, the use of antipruritic drugs became unnecessary in 6 patients, decreased in 5, and remained unchanged in 4. During the period of observation, no pruritus developed in non-pruritic patients. In study 2, during the use of 2000ml of rinsing solution, the levels of IgE, histamine, C3a and somatostatin in the pruritic group (n=7) and non-pruritic group (n=8) were measured at three different time points (before dialysis, 15 minutes after and 4 hours after dialysis). The IgE level remained high throughout the three time points in the pruritic group. The histamine level was high before dialysis and was decreased 15 minutes after, but rose again 4 hours after in both groups. The C3a level was found to be slightly high in both groups 15 minutes after but much higher in the pruritic group, and the somatostatin level remained high in the pruritic group in each time point of dialysis. In study 3, the levels of IgE, histamine, C3a and somatostatin were measured after the use of 1000ml of rinsing solution and were compared with those after the use of 2000ml. The patients (4 pruritic and 3 non-pruritic patients) included in Study 3 were recruited from the patients included in Study 2. When treated with 2000ml of rinsing solution, the IgE level was found to be low. The histamine level showed no significant difference throughout the dialysis session. The C3a level rose high after 15 minutes, and the somatostatin level was significantly (p<0.05) lower than that with use of 1000ml solution in all stages. These studies suggest that pruritus may be induced by substances in dialyzer rinsing solutions that have a possible relation to IgE and somatostatin. We thus conclude that increase of rinsing solution volume may have beneficial effects on pruritic patients.

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Purpose: To evaluate the hospitalization of pediatric patients undergoing chronic peritoneal dialysis.
Patients and methods: Seventy-eight children (46 boys, 32 girls, 0-15.9 years old at the start of dialysis) undergoing peritoneal dialysis for longer than one year were investigated. The patients were classified into three groups based on their age (A: under 3 years; B: 3-5 years; C: over 5 years) and into two groups based on the year of starting dialysis (before 1990 group, after 1991 group).
Results: The total annual length of hospitalization decreased progressively from the 1st to over the 3rd year of dialysis in all age groups. In group A, the total length of hospitalization in the 1st year was the highest. The duration of hospitalization at the start of dialysis was: A, 179.5 days (median of before 1990 group)·170.0 days (median of after 1991 group); B, 110.0·77.0 and C, 112.5·56.0. The total length of hospitalization was: A, 49.5 days/year·52.0 days/year (median); B: 49.0·29.0; and C: 33.0·20.0. The number of hospitalizations was 0.7-1.5 (median); there were no significant differences between the different age groups. Catheter trouble was the major factor responsible for hospitalization in all the age groups.
Conclusion: In the over 3 years age group, the hospitalization duration was decreased, but in the under 3 years age group, the total length of hospitalization per year was the highest, and was not reduced in children in whom dialysis was commenced after 1991. Prevention of catheter trouble was important for reduction of the length of hospitalization.

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