A continuous hematocrit (Hct) monitor, CRIT-LINE^TM, was used during double filtration plasmapheresis (DFPP), and the change in blood volume (BV) circulation was investigated in terms of a) volume of replacement fluid, b) concentration of replacement albumin fluid, and c) patient serum albumin concentration before treatment.
Patients with autoimmune disease and ABO-compatible or-incompatible renal transplants received DFPP under CRIT-LINE^TM monitoring. In these patients, BV fell gradually with an increase in the volume of replacement fluid. The corrected concentration of serum albumin decreased during treatment, indicating that albumin loss occurred during treatment. We speculated that the decrease in BV was induced by the fall in oncotic pressure caused by albumin loss, and often resulted in a fall in blood pressure. BV tended to decrease under conditions of a) high serum albumin concentration before treatment, b) low concentration of replacement albumin fluid and c) high level of replacement fluid.
A chart for fluid replacement was made specifying a BV decrease rate of less than 10% and a 70% IgG removal rate. When this chart was applied clinically, the target values were nearly attained; the BV decrease rate was 10.0±6.0% and the IgG removal rate was 69.6±8.9%.
Continuous Hct monitoring using the GRIT-LINE^TM is useful for the defection of changes in a patient's blood volume during DFPP. The new replacement fluid setting method described here was useful and may be effective in ensuring safe and effective treatment by limiting changes in blood volume.

View full abstract

In general, it is difficult to control blood pressure in diabetic hemodialysis patients (DM-HD). In this study, we evaluated serial changes in blood pressure during hemodialysis (HD), and orthostatic hypotension (OH) before and after HD in DM-HD compared to those in non-diabetic hemodialysis patients (non-DM-HD). The effects of amezinium metilsulfate (AM) on blood pressure during HD and OH after HD in DM-HD were also evaluated.
In both DM-HD and non-DM-HD (16 each), we measured blood pressure during HD and orthostatic changes in blood pressure before and after HD. In addition, we used a crit-line monitor to evaluate the serial changes in blood volume during HD.
Although there was no significant difference in water removal between DM-HD and non-DM-HD, DM-HD showed a significant decrease in blood pressure 2 hours after the start of HD, with a concomitant decrease in pulse rate. In contrast, there was no significant change in blood pressure or pulse rate in non-DM-HD.
There was no significant difference was seen in the orthostatic changes in blood pressure between DM-HD and non-DM-HD before HD. There was however, a marked OH (Δmean blood pressure: 20.5mmHg) in DM-HD compared with that in non-DM-HD (Δmean blood pressure: 6.8mmHg).
AM prevented the decrease in blood pressure during HD, but did not prevent OH after HD in DM-HD. In addition, this agent caused no significant change in circulating blood volume in DM-HD.
From these results, DM-HD are prone to decreases in blood pressure during HD, as well as to a marked OH with water removal as a result of HD. AM seems to be effective in preventing drops in blood pressure during HD, but not OH after HD in DM-HD.

View full abstract

The patient was a 53-year-old woman under chronic hemodialysis since 1982 after nephrectomy of both kidneys because of a polycystic kidney disease complicated by cystic infection. Although various examinations had been conducted since about 1996 because melena was frequently observed, the source of hemorrhaging could not be specified, and the patient was controlled with blood transfusions. On June 27, 2000, the patient showed a large amount of melena and was hospitalized for more detail examination and treatment. There was no clear source of hemorrhaging identified by abdominal CT or by upper or lower abdominal endoscopy. On the following day, integration of RI was observed in the right hypogastric region by a red blood cell scan (RBC scan). Because a hypervascular lesion was observed on angiography at a periphery of iliac artery, that is, at the bifurcation of the superior mesenteric artery (SMA), and a tortuous artery was identified in the periphery of the iliac artery, showin a peripheral stain, a partial resection of the small intestine was conducted on August 28. On perioperative findings, macroscopic vascularization was observed in the ileum 170cm from the ostium side of the terminal ileum, and 5cm on both sides of the small intestine were resected due to pathological findings of angiodysplasia (AGD). The patient had a history of surgery for carpal tunnel syndrome, but there was no amyloid deposition observed in the lesion of the small intestine.
There have been few patients undergoing maintenance dialysis in whom lesions causing intestinal bleeding could be identified, and this patient is the first case in which AGD was pathologically confirmed in Japan.

View full abstract

Neurotoxicity is well known to be associated with intravenous acyclovir (ACV) therapy. A 62-year-old man on CAPD was admitted to our hospital with fatigue and loss of appetite on September 27, 1999. He developed varicellazoster virus (VZV) skin eruption on the left side of the abdomen on October 18 and was treated with intravenous acyclovir (2.5mg/kg) once daily. He became disoriented in time and place with hallucinations and delirium two days after starting ACV therapy. We stopped ACV infusion, but the serum ACV level remained elevated to 30.0μM. His symptoms resolved within two days. The serum ACV level decreased to 0.8μM on the 3rd day and was less than 0.1μM on the 7th day.
Great care is needed before prescribing intravenous ACV for dialysis patients and it is imperative to control the serum ACV level using hemodialysis or apheresis.

View full abstract

A 67-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis due to Mycobacterium fortuitum. Reinsertion of a CAPD catheter, injection of urokinase and heparin into the new catheter were performed. Oral levofroxacin treatment was also continued for 2 months. After such therapy, the cloudy CAPD fluid became clear. However, peritonitis due to the same Mycobacterium relapsed within one week and the culture of dialysate remained positive despite the antibiotic therapy. The catheter was therefore removed. Thereafter, the patient presented sclerosing encapsulated peritonitis-like symptoms for 2-3 months because of severely prolonged peritonitis. It appears that the removal of CAPD catheter is the most appropriate method of eradicating Mycobacterium fortuitum-induced peritonitis, especially in patients who do not respond to antimicrobial therapy.

View full abstract

[in Japanese]

View full abstract