In Japan the average age of male chronic dialysis patients has gradually risen. Recently, the reports of male chronic dialysis patients with prostate cancer have been observed sporadically. Then, serum PSA screening was conducted to detect prostate cancer in male chronic dialysis patients with a low daily urine volume and minor complaints regarding voiding symptoms.
Sixty-six male chronic hemodialysis patients were included. The average patient age was 60.1 years old (from 37 to 83 years), their average hemodialysis period was 5.6 years (from 0.3 to 16.4 years). The serum PSA values were measured using the Tosoh PA II kit.
Serum PSA values ranged from 0.1 to 40.4ng/ml, but only 3 patients' serum PSA values were over 4ng/ml. In these 3 patients, transrectal prostate biopsy was performed under ultrasonic guidance. As result, prostate cancer was detected in 2 patients, but these patients had neither lymph node metastasis nor distant metastasis. The serum PSA screening was very effective for the early detection of prostate cancer in these 2 patients, because they had low daily urine volume and minor complaints related to voiding symptoms. In this study, the prostate cancer detection rate was 3% (2/66 patients). Except for the 2 prostate cancer patients, there was no correlation recognized between the hemodialysis period and serum PSA value, ages and serum PSA values in 64 patients. Based on these results, it is suggested that the serum PSA value in chronic hemodialysis patients is not affected by hemodialysis therapy.

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This study evaluated daily physical activity and sleep/wake patterns in patients on chronic dialysis.
A non-invasive and patient-friendly actigraph method was used as a parameter of daily physical activity and sleep/wake patterns.
Fourteen chronic dialysis patients were enrolled. The average age was 66.0 years and duration of dialysis was 6.9 years. Controls were 54 individuals without disturbance of daily activity.
The patients demonstrated lower levels of daily physical activity and higher levels during sleep than controls.
These data suggest that dialysis patients have a tendency toward more diteriorated levels of physical activity and disturbed sleep patterns.
Actigraphy is a useful method of evaluating daily physical activity and sleep disturbance in patients on chronic dialysis.

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Purpose and methods: To elucidate the optimal conditions for the hemodialysis facilities, 1) The available national standard for hospital facilities in Japan and the USA were investigated and reviewed. 2) facilities layout, passage of the department staff, distance between hemodialysis beds, as well as the passage of the patients from different parts of the hospital to the hemodialysis unit were analyzed at the Department of Blood Purification, Tokyo Medical and Dental University Hospital. Results: 1) while there is no Japanese standard for the hemodialysis facilities that contains provisions for infection control, in the USA, the American Institute of Architects offers a standard for hemodialysis facilities in its Guidelines for Hospital Facilities and Report on Infection Control, and the air changes per hour (ACH), distance between hemodialysis beds and protection of patient privacy are clearly defined. Standards for isolation rooms are similar in Japan and the US, however, the latter has additional standards such as ACH. 2) The movement of staff members was analyzed by observing their passage to and out of the utility sterilization room and isolation room. Traffic to and from the utility sterilization room is frequent during the initiation of the treatment and during the observation of treatment, and that to and from the isolation room was observed for 27 minutes each time at the beginning and end of treatment. During the observation period, there were five entries into the isolation room that lasted seven minutes each. Minimum distance of 80cm was required for standard dialysis beds and 120cm for infection beds considering the potential for blood spillage. A screen between the standard dialysis beds secured the privacy of the patients visually, however, conversation and various sounds could be overheard. Conclusion: It was not considered possible to immediately comply with the guidelines of American Institute of Architects and to incorporate the results of this study of recommendations from literature on hospital design and facilities. However, considering the fact that the outpatient dialysis for infectious patients is being performed, infection-resistant facility design in critically important. Standards for a hemodialysis facilities design with provisions for the prevention of the nosocomial infection and medico-economic considerations must be established. Current study indicates that facilities and design play important roles in infection control in hemodialysis units.

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Reinfusion of ultrafiltrated and concentrated ascites refers to the re-utilization of autoprotein, and is useful for the effective utilization of resources. However, a high incidence of fever and chills are observed as side effects, preventing the widespread use of this procedure. A recent study reported that interleukin-6 (IL-6) levels in ascites are increased by this procedure, and we speculated that IL-6 may be involved in inducing fever. In 5 patients with refractory ascites in whom reinfusion of ultrafiltrated and concentrated ascites induced fever, we examined IL-6 levels in treated ascites and changes in blood IL-6 levels and body temperature at 1 hour, 2 hours, and 12 hours (24 hours in some patients) after the start of intravenous infusion. As a result, in all patients, blood IL-6 levels peaked 1 hour after the start of intravenous infusion, gradually decreased, and returned to the pretreatment values 12 hours after the start of intravenous infusion. In all patients, body temperature was highest 2 hours after the start of intravenous infusion, but returned to the pretreatment value 12 hours after the start of intravenous infusion. Thus, from the findings in this study we speculated that IL-6 may be involved in inducing fever.

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We recognized that controlling the concentrations of the B solution and the diaysate is useful for safely managing dialysis treatment. At present, an analysis instrument based on electrode method is widely being used in clinical laboratories to measure the electrolytes in blood.
When the electrolyte concentrations were determined in the prepared dialysate and B solution with analysis instrument described above, we could not obtain satisfactory results with regard to precision and accuracy for the B solution.
In this paper, we loaded the electrolyte analysis instrument EX-180 (JOKOH Ltd.) after readjusting the sample volume and the calibration for the dialysate. Then the electrolytes were determined in the prepared dialysate and the B solution.
We obtained a reasonable result with the instrument, which is useful for the routine control determinations of the prepared dialysate and the B solution.

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The first case was a 49-year-old man with end-stage renal failure maintained on hemodialysis for 20 years, who was admitted to our hospital for parathyroidectomy. He had dark-red asymptomatic hyperpigmentations on his thighs. A skin biopsy revealed small vessel calcification in the dermis and subcutaneous adipose tissues, leading to a diagnosis of calciphylaxis. The hyperpigmentations attenuated after parathyroidectomy. The second case was a 75-year-old woman who had been on hemodialysis for 7 years and had severe hyperparathyroidism. She was admitted for painful purpura on her left thigh. She developed ulceration in a few weeks and a skin biopsy revealed numerous calcifications in small vessels and necrotic fat tissues, leading to a diagnosis of calcifying panniculitis. She underwent repeated debriedement of ulcers and skin autografting but responded poorly. The patient refused parathyroidectomy and she died of sudden cardio-pulmonary arrest. The family refused autopsy.
Recently calciphylaxis has been reported to predominantly involve the thighs and abdomen (proximal calciphylaxis), and has also been noted in patients with normal PTH levels and minimal Ca and P abnormalities. To establish specific therapeutic regimens for this life-threatening syndrome, a clear understanding of the pathogenesis is indispensable.

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We present a 69-year-old female on chronic hemodialysis developed multiple lung abscesses due to Staphylococcus aureus after bacteremia associated with puncture-site infection of the internal arteriovenous fistula in the left forearm.
The patient has undergone maintenance hemodialysis at our hospital due to chronic pyelonephritis since September 1994. She came to our hospital with complaint of high grade fever and erythema at the puncture-site. Despite immediate initiation of anti-biotics therapy for puncture-site infection, we recognized abnormal shadow of right upper lobe on chest X-ray four days after admission. Staphylococcus aureus was isolated from blood, sputum and secretion from the puncture-site. Piperacillin sodium (PIPC) therapy for six weeks and Levofloxacin (LVFX) for two weeks gave good results.
Patients subjected to chronic hemodialysis are especially prone to infections because of the impaired immune response, treatment in the hospital and the repeated vascular exposure to bacterial invasion. Therefore, special care is necessary to avoid infection in hemodialysis patients.

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