In some patients on chronic hemodialysis, serum phosphorus (P) levels were decreased during administration of Colestimide, a hypercholesterolemia drug that absorbs bile acid.
This study investigated the effectiveness of Colestimide as a phosphate binder. Serum P levels were determined before and after treatment with Colestimide for 4 weeks in 31 prospective patients and the results were as follows:
1) There was no difference in serum P levels at 4, 2, and 0 weeks before treatment, but those levels decreased significantly with Colestimide treatment from 6.1±1.1mg/dl to 5.5±1.2, 5.4±1.1 and 5.3±1.2mg/dl at 2, 3 and 4 weeks after treatment (p<0.0001 repeated measure ANOVA). Decrease in the mean serum P level was significant after 2 weeks (Dunnett multiple comparison).
2) The total serum calcium (Ca) concentration showed no significant difference at 4, 2 and 0 weeks before treatment. The total serum Ca concentration decreased significantly at 1, 2, 3, and 4 weeks after Colestimide treatment (p=0.0029 repeated measure ANOVA). The total serum Ca concentration decreased from 9.8±0.6mg/dl to 9.5±0.8mg/dl and 9.5±0.7mg/dl at 3 and 4 weeks after Colestimide treatment, respectively and the decrease was significant after 3 weeks (Dunnett multiple comparison). Blood Ca ion levels, however, were changed from 2.61±0.15mEq/l to 2.58±0.16mEq/l, showing little difference. Serum levels of total protein and albumin also showed little change after Colestimide treatment; therefore, it was suggested that the lowered total Ca level might be specifically attributed to complex Ca.
This study showed that Colestimide treatment could control serum P level without causing hypercalcemia and that it may be feasible to co-administer active vitamin D medication. Based on this study, Colestimide was highly recommended for use as a non-absorbable phosphate binder.

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The nutritional effect of microencapsulated bifidobacterium on hemodialysis patients was evaluated.
The subjects were 20 hemodialysis patients. The mean age was 56.1±11.8 (mean±standard deviation) years old and mean period on dialysis was 6.5±4.5 years. After restriction of oral lactobacilli products for 2 weeks, the patients were given 0.9g/day microencapsulated bifidobacterium orally for 4 weeks. Then, the same regimen was given for 20 weeks without restricting oral lactobacilli products.
Bowel movement and the related symptoms were recorded. Protein catabolic rate (PCR), Kt/V, time averaged concentration of blood urea nitrogen (TACBUN), oral sodium, potassium, energy intake, serum creatinine, serum albumin and total cholesterol were analyzed before, and on the 2nd, 4th, 6th, 8th and 24th week after initiating oral intake of microencapsulated bifidobacterium.
PCR, TACBUN and energy intake were increased at the 2nd and the 24th weeks significantly in comparing with their baseline values. Bowel movement and the related symptom scores gradually improved. Other nutritional markers such as serum albumin, total protein and total cholesterol were unchanged.
It is suggested that oral intake of microencapsulated bifidobacterium may contribute in improving the nutritional status of the hemodialysis patients. Further investigations involving a large-scale study are needed.

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This study investigated the clinical effects of CCPD therapy for patients with minimal residual renal function. Ten CAPD patients (duration of CAPD: 53.5±23.4 months, age: 47.2±4.8 year old, all males) who showed uremic symptoms clinically due to loss of residual renal functions, were transferred to CCPD therapy. In those 10 cases, peritoneal dialysis dose and the clinical parameters were analyzed just before withdrawal from CAPD (period on CAPD) and the 12 months after the induction of CCPD (period on CCPD). Regarding dialysis dose, compared to the period on CAPD, there were significant increases in creatinine clearance (Cl) and Kt/V during the period on CCPD. However, there were no changes in β₂microglobulin Cl. Clinically, uremic symptoms observed during the period on CAPD in all cases, were all well controlled during period on CCPD. The results of our observation suggest that CCPD could well increase small solute Cl and control uremic symptoms in patients with loss of residual renal function at least during the short-term trial. However, the Cl effect of midsized molecules on CCPD remains unclear, and long-term observations are required.

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We evaluated indications for renal transplantation (RT) and the possibility of living renal donation in patients with chronic renal failure (CRF) and patients on hemodialysis (HD). Of the 39 CRF patients, 15 were recognized as having indications for RT, and all 15 preferred RT to HD; 9 of the 15 ultimately obtained related or unrelated living renal donation. Of the 86 patients on HD, 31 had indications for RT and 11 of the 31 wanted RT, though not all were able to obtain living renal donation. Patients on HD tended not to prefer RT, because it is speculated that this is a reflection of the reluctance to obtain living renal donation from related or emotionally related persons. Since 1997 living RT has been performed in 12 patients with end-stage renal failure at our institution, which resulted in a satisfactory outcome to date. Although there are ethical problems in performing living RT, in view of the absolute shortage of cadaver renal donation, living RT is an important therapy for patients with end-stage renal failure. Providing sufficient information about RT is necessary to promote RT.

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A 26-year-old man presented with both spontaneous severe knee pain and the inability to support his weight after attempting to rise from a sitting to a standing position. His past medical history was significant for endstage renal disease maintenance dialysis for 16 years (including continuous ambulatory peritoneal dialysis for 12 years resulting in sclerosing encapsulating peritonitis or SEP and subsequent hemodialysis for 4 years), with SEP-induced ileus treated with home parenteral nutrition, dilated cardiomyopathy due to selenium deficiency and secondary hyperparathyroidism. He had markedly elevated serum alkaline phosphatase, intact parathyroid hormone and β₂-microglobulin levels. Ultrasonography and magnetic resonance imaging of the knees indicated ruptures of both quadriceps tendons at the upper margins of the patella. Surgery was performed. Pathologic examination revealed degenerative changes, mild inflammation and pseudoosteogenesis in the tendons, and also showed negative Congo-red and β₂-microglobulin staining of the ruptured tendon specimens. These findings suggest that secondary hyperparathyroidism seem likely to play a major role. However, long-term dialysis and parentral nutrition may also be associated with contrbuting factors.

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We report two hemodialysis patients with spontaneous renal rupture. The first case involved, a 49-year-old male on chronic hemodialysis for 13.5 years, who was referred to our hospital with sudden left abdominal pain. Computed tomography demonstrated bilateral acquired cystic disease of the kidney (ACDK), left renal rupture and perinephric hematoma. A few hours after admission, the patient was in a state of hemorrhagic shock. Since we thought it was difficult to continue conservative therapy, emergent left nephrectomy was performed. Pathological examination revealed small renal cell carcinoma. Seventy-eight months after nephrectomy, no recurrence or metastasis has been detected.
The second case involved, a 57-year-old male on chronic hemodialysis for 2 years, who was referred to our hospital with grosshematuria and right back pain. Ultrasound echography and computed tomography demonstrated right renal hemorrhage. Because his general condition was comparatively good, we decided to treat him conservatively. Twenty-four months after hemorrhage, there has not been any new hemorrhage.
We discuss spontaneous renal rupture and its treatment in hemodialysis patients.

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We presented a case of pneumoperitoneum caused by technical error during peritoneal dialysis using cycler. The patient was a 62-year-old man on peritoneal dialysis for 4 years. He had required peritoneal dialysis using cycler for the last 2 years. When the patient broke the click-tip of a bag for priming the cycler, he accidentally made pinhole in the bag. He noted massive volume of air entering the peritoneum, immediately after the cycler was started. Subsequently, he developed dyspnea and acute abdominal pain. He came to the hospital next day. A chest X-ray film disclosed an air shadow measuring 38mm in diameter.
Although peritoneal air was absorbed spontaneously, the ultra-filtration volume was reduced by 12% after 3 months. These findings indicate that pneumoperitoneum may induce ultrafiltration failure.

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