The effectiveness of cleansing with soap and water for daily peritoneal dialysis catheter exit site care in patients with well-healed exit sites was evaluated. The incidence of exit site infection was 0.91 episodes per patient year in patients whose exit site care consisted of swabbing with povidone iodine alone. After introducing cleansing with soap and water in addition to swabbing with povidone iodine, the incidence of exit site infection was reduced to 0.09 episodes per patient year (p<0.01, N=20, observation periods 21.1±3.1 months). In 16 patients, swabbing with povidone iodine was discontinued for the next 11.7±1.6 months. The incidence of exit site infection during this period was 0.11 episodes per patient year. There was no significant change in the incidence of exit site infection after the use of povidone iodine discontinued (p=0.626).
The present study showed that cleansing the peritoneal dialysis catheter exit site with soap and water resulted in a low incidence of exit site infection and the addition of povidone iodine was not necessary as daily exit site care in CAPD patients with well-healed exit sites.

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Recent studies have demonstrated that an elevated level of sulfur amino homocysteine (hcy) is a strong and independent risk factor for premature cardiovascular disease in renal failure. However, little is known about the contribution of folate concentrations to hyperhomocysteinemia in hemodialysis patients. Therefore, we measured plasma concentrations of hcy and serum concentrations of folate in 66 hemodialysis patients. Mean±SD plasma hcy level was 45.6±31.9μmol/l (12.6-182.0μmol/l) and mean±SD serum concentrations of folate was 7.5±4.1ng/ml (2.7-26.8ng/ml). Although serum folate levels were within the normal range (2.4-9.8ng/ml) in 57 (86%) patients, 11 (19%) of 57 had extraordinary high plasma homocysteine levels (>60μmol/l). These normal concentrations of folate were not sufficient to reduce hyperhomocysteinemia in hemodialysis patients. In contrast, there were no patients with folate concentrations of 15ng/ml or higher showing homocysteine levels above 40μmol/l. Furthermore, plasma hcy levels were negatively correlated with serum concentrations of folate (r=-0.245; P=0.0445). These data strongly suggest that serum concentrations of folate should be maintained at supraphysiologic levels in hemodialysis patients.

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Database software was tentatively developed to calculate the optimal parameters of dialysis levels, such as Kt/V for the urea and protein catabolic rate (PCR), according to the method proposed by the Statistic Investigation Committee of the Japanese Society for Dialysis Therapy. For use in obtaining informed consent, data entry operations are simplified and data are graphically presented. Furthermore, the database software includes a dialysis condition simulation function and the database software was runtime-packaged to allow data distribution to other facilities. Changes in dialysis parameters caused by adjustments to the dialysis condition were investigated for one year in our clinic using the database. As a result, it was revealed that Kt/V for urea improved from 1.31±0.19 to 1.52±0.17. A dialysis condition simulation showed a relationship between the actual dialysis time and the estimated dialysis time with a correlation coefficient of 0.681. The runtime database software package may play a supporting role not only in dialysis parameter calculation but also in dialysis condition re-adjustment toward a target level.

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Purpose; We investigated the effects of vitamin K₂ (VitK₂) administration on bone mineral density and turnover in maintenance dialysis patients with hypoparathyroidism (HypoP).
Methods; Thirty-nine dialysis patients (hemodialysis 30, peritoneal dialysis 9) whose baseline plasma intact PTH (iPTH) was less than 65pg/ml were divided into the treated group (VitK₂ group) and the control group (C group). The bone mineral density (BMD) of the second middle phalanx was measured by digital image processing technique. The age, gender, dialysis duration, body mass index, renal diseases and BMD in the two groups were identical. The VitK₂ group received 45mg menatetrenone per day orally for 12 months. The BMD, iPTH and intact osteocalcin (OC) were measured at 6th and 12th month.
Results; There were no significant changes of the BMD were demonstrated during 12 months in both groups (VitK₂ group, 2.39±0.48→2.40±0.53mmAl; C group, 2.60±0.39→2.63±0.40mmAl). There was a significant increase in iPTH after 12 months in the VitK₂ group (VitK₂ group, 32±16→51±42pg/ml; p<0.01; C group, 34±20→38±39pg/ml). However, iOC, calcium and phosphate did not show any significant changes during 12 months in both groups (iOC VitK₂ group, 19±14→23±16ng/ml; C group, 17±11→14±7ng/ml). In the VitK₂ group, 6 patients whose iPTH increased 1.5 times or more from baseline at the 12th month showed a significant decrease in calcium (p<0.05) and insignificant increase in iOC (p=0.12). Conclusions; VitK₂ administration for 12 months did not show a significant effect on the BMD of the second middle phalanx in HypoP dialysis patients. However, VitK₂ might induce changes in bone turnover and parathyroid function in those patients.

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Though plasmapheresis has been widely employed for treatment of demyelinating neurological disorders such as Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP), the indications and protocols for this treatment remain controversial.
To evaluate the efficacy of plasmapheresis for these disorders, we reviewed a total of 26 treatments in 24 patients who underwent plasmapheresis in our hospital between January 1987 and September 1999: Fifteen patients with GBS, 4 with CIDP, 2 with Crow-Fukase syndrome (CFS), 1 with multiple sclerosis (MS), 1 with Miller-Fisher syndrome and 1 with acute inflammatory demyelinating polyneuropathy. A total of 147 sessions were performed, including 75 plasma exchange (PE), 60 double fitration plasmapheresis (DFPP) and 12 immunoadsorption (IA).
Neurological improvement was assessed by grading on the Hughes' scale as well as by the subjective symptoms. Among 16 GBS cases, plasmapheresis was highly effective in 8, effective in 4, and ineffecive in 3. In one case, the effect was not clearly determined. There was no difference in efficacy among PE, DFPP and IA. Plasmapheresis was effective in only 1 of 4 CIDP patients and the effect was transient. Two CFS cases and 1 MS case showed partial effectiveness. Severe side effects were observed in 2 cases-one resulting in death and the other in respiratory arrest.
In conclusion, plasmapheresis can be considered a very effective treatment for GBS patients, while it could also be employed in CIDP, CFS and MS if conventional therapy is not effective.

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Health-related quality of life (QOL) in patients on chronic hemodialysis was assessed using the SF-36 questionnaire. One hundred and eighty three patients were enrolled. The average age was 59.5 years and the average duration of hemodialysis was 6.9 years. The QOL scores of these patients were below normal.
Factors that reduced the patient's QOL score were aging, the duration of hemodialysis and hypoalbuminemia. From the perspective of complications, malignant disease, diabetes mellitus, problems with blood access, ischemic change on ECG, history of surgery on the extremities and dialysis-related amyloidosis reduced the QOL score. Judging from symptoms of the patients, being bothered by washed out or drained feeling, soreness of muscles, shortness of breath, lack of appetite and numbness in the hands and feet are related to a reduction in the QOL score.
From this evaluation, medical staff should be care for these patient's symptoms. Appropriate correspondence is required to improve the QOL of the patients.

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We report a case of living renal transplantation in a boy who had been undergoing continous ambulatory peritoneal dialysis (CAPD) because of end stage renal disease due to branchio-oto-renal syndrome (BOR syndrome). The coexistence of preauricular pits, hearing loss, branchial fistulae and renal anomalies is known as BOR syndrome. An 11-year-old boy had been undergoing CAPD for one year due to chronic renal failure. His medical history disclosed a slight degree of deafness, and proteinuria had been detected at three years of age. He underwent surgery for branchial cleft fistula at nine years of age, and a diagnosis of BOR syndrome was made. His family history revealed branchial clefts in both his sister and his mother. His renal function thereafter gradually deteriorated, and he underwent CAPD at ten years of age. He had several episodes of peritonitis, and therefore his parents decided to donate a kidney.
His mother's renal function was slightly impaired (creatinine clearance; 72ml/min), in addition she also had a history of a branchial cleft which closed spontaneously when she was a child and complained of a slight degree of deafness. As a result, the boy's father donated his left kidney to the patient. Renal transplantation was successfully performed following the removal of the CAPD catheter, and immediate diuresis did not necessitate hemodialysis. Azathioprine, Cyclosporine A, and prednisolone were all administered for immunosuppression. The postoperative course was uneventful, and the graft has also been functioning well.

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