The body water change in hemodialysis patients was evaluated by the bioelectrical impedance method using a body composition analyzer (BCA). Sixty-four hemodialysis patients were selected from our clinic.
Method: TBW (total body water) which was calculated from UFV (ultrafiltration volume) and BCA was compared before and after hemodialysis. Then the patients were divided into two groups according to the treatment of hypotension during hemodialysis; The control group consisted of 29 patients who did not have any hypotension treatment for 13 hemodialysis treatments before BCA measurement. The other is the hypotension group with 35 patients who needed more than 5 hypotension treatments during 13 hemodialysis treatments before BCA mesurement. TBW change was also compared between these two groups.
Results: UFV was not identical to the difference in TBW after hemodialysis. Because of the discrepancy, we hypothesized that the analysis should be done using the data after hemodialysis.
As UFV and the difference in normalized TBW after hemodialysis were almost identical (r=0.94), the following evaluation was performed using our established normalized value. Although, in the control, normalized ICW/ECW did not change before and after hemodialysis (r=0.77), a change before and after hemodialysis was observed in the hypotension group. Reduction rates of both normalized ECW and ICW were correlated with Δn-TBW in both the control and hypotension group.
In the hypotension group, as ECW decreased, ICW was further increased. The concentration of hematocrit (Ht) and serum albumin (AIb) after hemodialysis in the hypotension group significantly differed from that in the control. Those results indicate that dehydration in vessels was dominant in the hypotension group, whose body water can easily move from ECW to ICW during hemodialysis.

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Introduction and objectives: We previously demonstrated that bladder cancer patients with end-stage renal disease (ESRD) were rare, but those with high grade tumor or an advanced stage had an unfavorable prognosis. We studied the prognosis of bladder cancer patients with ESRD by long-term follow-up after surgery, and discuss bladder cancer detection and surgical therapy in these patients.
Materials and methods: Between April 1980 and March 2001, six bladder cancer patients with ESRD who underwent surgery in our institute were studied. The study group consisted of 5 men and 1 woman with a mean age of 64 years and a mean hemodiafysis duration of 35 months. All patients consulted our institution with chief compliant of macroscopic hematuria and initially underwent to transurethral resection of bladder tumor (TUR-Bt).
Results: Before surgery, urine cytology showed class V in 4 patients with high-grade tumor (grade II or more). Two of 6 patients died due to bladder cancer progression after surgery (transitional cell carcinoma>adenocarcinoma, grade III, pT2 and squamos cell carcinoma>transitional cell carcinoma>adenocarcinoma, grade II, pT4) and 1 patient died due to surgical complication after radical cystoprostatectomy (transitional cell carcinoma grade II, pT3a). The remaining 3 patients survived after TUR-Bt with a mean follow-up time of 51 months (Three TUR-Bt sessions were performed in 1 patient with transitional cell carcinoma grade I, and 1 TUR-Bt in 2 with transitional cell carcinoma grade I and II, respectively).
Conclusions: This study demonstrated that bladder cancer patients with ESRD have an unfavorable prognosis after surgery. These results reflect that patients with ESRD have a higher risk of high grade advanced stage tumor. Therefore, early detection of bladder cancer by bladder washing cytology or cystosopy is particularly important in these patients.

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Recently, the numbers of elderly patients requiring hemodialysis have increased in Japan. A lack of sufficient medical and nursing institutions with skillful staff for aged people is a public health problems. Even under these circumstances, many patients hope to maintain their quality of life (QOL) by receiving care services not in an institution but at home. The outpatient hemodialysis units are also facing various problems in such patients such as reducing mortality rates and maintaining patient mobility despite physical disabilities and background social issues. To support such patients, we set up a visiting nurse station in our hemodialysis unit.
This retrospective study evaluated the role of the visiting nurse station attached to the outpatient hemodialysis unit. Seven hemodialysis outpatients' clinical parameters, i.e. the ratio of body weight gain (two-day interval), the number of treatments during the hemodialysis period, the value of Kt/V, nPCR, Ca, P and CaCO₃ dosage were compared before and after receiving domiciliary nursing and/or domiciliary assistance.
Not only clinical parameters but also the patients' physical and psychological responses showed improvements in this study. It is also more likely that the patient' QOL were improved. It appears that the visiting nurse station attached to the outpatient hemodialysis unit is useful for managing elderly hemodialysis outpatients.

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To examine the validity of water removal control by the BVM of the Fresenius 4008S, an in vivo study was carried out in eight ESRD patients. Relative blood volume (RBV), defined as blood volume (BV) divided by its initial value, and blood pressure (BP) drop during treatment was examined between dialysis treatments with and without BVM of the machine. The ultrafiltration rate (UFR) define control strategy was determined as follows: we inputted the critical RBV value for each patient to the BVM based on his/her condition, and the BVM was started with twice the preset UFR value then the UFR value was reduced but not allowed to reach critical RBV after the RBV reach half the critical RBV.
In this study, an index for BV change defined as plasma refilling rate (PRR) divided by ultrafiltration rate (UFR) was newly introduced to estimate the degree of the water transfer from or to the patient's intravascular compartment. Time-averaged PRR/UFR value with BVM was obtained as 0.83±0.02, significantly higher than that without BVM of 0.72±0.03 (p<0.01 by a paired T-test) under the same total amount of ultrafiltration (UF). The RBV value during the treatment was also obtained higher in HD with BVM of 0.79±0.04 than that in the HD without BVM of 0.76±0.07 (N. S. by paired T-test). This means the UFR control by the BVM maintained higher plasma refilling during treatment due to the achievement of adequate water removal corresponding to the patient's circulation. None of the patients demonstrated a higher BV drop in the HD with BVM. The validity of the UFR control system by the BVM, thus, was verified during this study. The BVM seems to be effective for establishing “physiological dialysis”.

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In this paper, we evaluated functional duration of a semi-permanent dual lumen catheter (SOFT-CELL) in 5 chronic hemodialysis patients inserted into right internal jugular vein focusing on the catheter position and the blood flow rate.
We evaluated the position (the caval atrial junction and the higher site of the superior vena cava) and the blood flow of the catheter using trans-luminal angiography and percutaneous ultrasonography. The catheter with its tip just around the level of the caval atrial junction had longer survival in three patients (from 15 to 35 months). Venous blood flow rate at that position was 20-60cm/sec lower than that at the other site. Kt/V was 1.14-1.32 in all patients.

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The peritoneal equilibration test (PET) is a useful method of evaluating the peritoneal membrane characteristics in an individual patient. However, the procedure is rather complex. This problem sometimes becomes an obstacle to repeating PET periodically. However, fast PET is an alternative method, although these results are not reliable in patients whose peritoneal catheters drain poorly. We postulated that patients could perform PET at home if they are thoroughly educated about the procedure. For this purpose, we prepared visual aids (VCR, and brochure with photographs). PET was performed in 9 cases where twin-bag systems were used. To mark fluid level indicator lines (200mL and 10mL), patients received a guide sheet on which the fresh dialysate bag was placed. After an 8-12 hour overnight dwell, the dwelled dialysate was drained completely into the empty bag. Immediately after infusing 2L of a 2.5% dialysis solution, 200mL of the solution was drained into the bag on which the two fluids levels were previously marked. After mixing, about 190mL of dialysate was reinfused and the remaining 10mL, the amount indicated by a guide mark at the corner, was left within the bag. After a 4 hour dwell, the dialysate was completely drained into another twin bag. The standard PET was also performed on a different day and the data were compared with that obtained by Home PET (N=9). There were significant correlations in D/D0 and in drain volume between the Home PET and Standard PET (0.387±0.059 vs. 0.38±0.053, r=0.874 p=0.0009; 2336±136.5 vs. 2376±97.2, r=0.814 p=0.0053, respectively). There was no relation in the residual volume of Home PET (70mL-484mL). Home PET is a clinically useful alternative to the standard PET and saves time and labor while maintaining accuracy.

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We report a case of spontaneous rupture of the esophagus in a 64-year-old man who had been under hemodialysis since 1990. On 16 March 2000, he presented with severe back pain and hematemesis after vomiting. He appeared severely ill and chest X-P demonstrated right pleural effusion. Under tentative diagnosis of dissecting aneurythm, he was transferred to our hospital. Chest CT demonstrated right hydropnuemothorax and massive air and food residue were exhausted from the right pleural drainage tube. Since a gastrografin study demonstrated marked extravasation from the esophagus to the mediastinum and right pleural space, he was diagnosed with rupture of esophagus. A right thoracotomy (right pleural drainage, resection of intra-thoracic esophagus, esophagostomy, gastrostomy) was performed. He is currently well and has been on hemodialysis as an out-patient.

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