[Purpose] This study evaluated sexual function and risk factors in male patients on hemodialysis and also studied the efficacy of sildenafil citrate (VIAGRA®).
[Patients and Methods] A questionnaire survey was conducted among 46 male hemodialysis patients aged under 65 years (HD group) and 45 normal males (control group) for comparison. Correlations between age, history of hemodialysis, weight gain rate, DM, testosterone, BUN, prolactin, Hb, T-chol., TG, intact-PTH and β₂-MG and other factors were examined, and possible risk factors were studied. For 5 patients wishing to take VIAGRA®, it was prescribed after performing Rigiscan.
[Results] The scores for all issues in the questionnaire were significantly lower in the HD group than in the control group. However, when the ages of subjects was younger, the difference became smaller and a significant difference was no longer found for any issues when a comparison was made in patients of younger below 40. Regarding the correlation between the factors and questionnaire items, age was correlated significantry with 6 items, testosterone, and TG with 4 items, and intact-PTH with 3 items. VIAGRA® was markedly effective in 2 cases with normal Rigiscan patterns, in 1 case showing shortened episode, effective in 1 of 2 cases showing a flat trace, and ineffective in 1 case. The efficacy rate was 80%. There were no serious adverse-effect of VIAGRA®.
[Conclusion] In our study, it was confirmed that male patients on hemodialysis developed sexual dysfunction concurrently. However, it was shown that sexual function was maintained in younger patients. Age was shown to be the strongest risk factor, and the increased risk of sexual function in male HD patients became marked with aging.

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Objectives: Many reports have demonstrated that patients with acquired cystic disease of the kidney (ACDK) are frequently complicated of renal cell carcinoma. We evaluated the clinicopathological features of renal cell carcinoma (RCC) occuring in chronic hemo-(peritoneal) dialysis in 14 patients, including those with ACDK between June 1991 and December 2001. We analyzed demographics, hemodialysis duration, pathological characteristics of the tumors and prognosis of these patients over an 11-year follow-up.
Patients and Methods: We retrospectively reviewed the record of 14 consecutive patients with RCC ranging from 39 to 75 years old (mean age 54.5), 12 males and 2 females. As for the underlying disease causing renal failure, chronic glomerulonephritis and IgA nephropathy were noted in 13 and 1 patient, respectively. There was no diabetes mellitus patient in this series. The duration of hemodialysis ranged from 28 to 300 months, 143 months, in average.
As for the main diagnostic methods, CT was performed in 8 cases, ultrasonography in 6 cases. Four patients demonstrated symptoms; macroscopic hematuria in 3, and low grade fever in 1 case.
Results: Nephrectomy was performed for the bilateral kidneys in 2 patients, and for the right kidney in 10 patients, and the left kidney in 2 patients. Open surgery was performed in all cases using the translumbar approach for 14 kidneys and transabdominal approach for 2 kidneys. Surgical duration ranged from 100 to 390 minutes, in average 220 min. Bleeding volume ranged from 44 to 1305mL, in average 396mL. In the most recent case, who was suspected to have bilateral RCC complicated with ACDK, bilateral nephrectomy was performed at different times, althogh the left kidney, which was resected later, did not show any evidence of malignancy. We felt keenly that preoperative diagnosis was very difficult. As for the complications during and after surgery, disseminated intravascular coagulation and congestive heart failure were encountered in one patient with stage T4 disease (pancreatic invasion), but no other complication was encountered.

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Rehabilitation is an important concern in patients receiving dialysis, because they often have diseases that impair physical activities. The present study compared the effect of rehabilitation between 19 diabetic (DM) patients and 28 non-diabetic (NDM) patients who were admitted to our hospital and received hemodialysis between April 1996 and November 2000. The duration of hemodialysis was significantly shorter in DM patients than in NDM patients (50.2±40.1 vs. 97.3±94.4 months, p<0.05). The most frequent condition requiring rehabilitation therapy was stroke (cerebral infarction or hemorrhage). The duration of hospitalization and of rehabilitation was slightly but not significantly longer in DM patients (106.7±117.8 and 74.3±96.6 days, respectively) than in NDM patients (90.1±62.9 and 64.6±64.7 days, respectively). The total Barthel index score of daily physical activity was similar in the two groups before rehabilitation. The total Barthel index score was significantly improved after rehabilitation in both groups (p<0.04, p<0.002, respectively). There was a significant negative correlation between the duration of hospitalization or the duration of rehabilitation and the total Barthel index score before rehabilitation in both groups (r=-0.463, r=-0.490, respectively). When the patients were divided into 2 groups, according to the index score before rehabilitation (less than 60, n=18; 60 or more, n=29), the duration of hospitalization and of rehabilitation was significantly shorter in the group with the higher score (66.9±65.9 and 36.2±46.5 days, respectively) than in the group with the lower score (144.9±100.2 and 120.5±91.6 days, respectively; p<0.0005). These results suggest that DM patients who are under hemodialysis should be encouraged to receive rehabilitation if it is indicated.

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Purpose: Retrospective study of patients with end-stage renal disease (ESRD) who received continuous ambulatory peritoneal dialysis (CAPD) therapy at the Dialysis Center, Jichi Medical School Hospital from 1982 to 2001 was performed.
Results: The total number of patients was 122 (male and female, 83 and 39, respectively), mean age at initiation of CAPD was 48.6±1.3 years old. There were 87 patients with positive introduction and 35 with negative introduction. Mean duration of CAPD therapy was 48.2±4.2 months. The mean number of CAPD-related peritonitis episodes was 1.7±0.29 times. Main causes of ESRD were chronic glomerulonephritis (75 patients), diabetes mellitus (24), nephrosclerosis (11), and systemic lupus erythematodus (3). The main reasons for withdrawal of CAPD were peritonitis/tunnel infection (32 patients), death (18), and ultrafiltration failure (14). The main causes of death were cerebrovascular disease (4 patients), lethal arrhythmia (3), heart failure (3) and bacterial peritonitis (2). Patients who were over 65 years old, diabetic or of the negative selection group had a shorter duration of CAPD therapy compared with the other group. The frequency of CAPD-related peritonitis was one episode/39.3 patient-months. There was one episode/21.3 patient-month before 1990, and one episode/65.9 patient-months after 1990. The duration of CAPD therapy did not significantly differ between diabetics and non-diabetics in the positive selection group. By Cox proportional hazard model, patient selection and the frequency of CAPD-related peritonitis could be explanatory variables. These results suggested that improvement of the method of exchanging the CAPD bag system reduced peritonitis rates, but did not impact technique survival. Patient selection, improvement of CAPD solution and conquest of encapsulating peritoneal sclerosis (EPS) may lead to much longer continuation of CAPD therapy.

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Radiological examinations using contrast medium are routinely performed in patients with renal insufficiency. Since intravascularly administered contrast medium is retained in patients with renal dysfunction, prophylactic hemodialysis has been indicated routinely immediately after examination in all patients with renal insufficiency.
In the present study, we examined the pharmacokinetics of contrast medium elimination during hemodialysis after cardiac angiography. The subjects were 8 patients with end-stage renal disease on regular hemodialysis and 4 patients with impaired renal function. In both groups, contrast medium was eventually eliminated over time. The mean removal rate of iodine present in the circulation at the start of dialysis was 44.6% after one hour, 60.5% after two hours, 71.4% after three hours and 85.1% at the end of dialysis. Mean iodine clearance at 15 min and 30 min was 110mL/min and 113mL/min, respectively.
In patients with impaired renal function, who were not dialyzed regularly, we examined urine iodine concentration in addition to blood iodine concentration. Urine iodine concentration was higher than blood iodine concentration. High urine iodine concentration was evident for a long time, and was even detected the following morning. Blood iodine concentration after radiological examination showed a strong correlation (r=0.82, p<0.001) with the volume of contrast medium per body weight (mL/kg), facilitating prediction of blood iodine concentration by calculation. This process has the potential to assist decision-making on whether to carry out dialysis to eliminate contrast medium after radiological examination.
Hemodialysis proved to be an effective method for removing iodine. Since high concentrations of iodine were detected in the urine of patients with impaired renal function, dialysis and sufficient per oral or intravenous fluids should be routinely prescribed before and for a few days after radiocontrast procedure in order to ensure a high urine output.

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Biological actions of serum calcium is known to be related to ionized calcium, rather than total calcium, approximately half of which is bound to serum proteins. The measurement of ionized calcium has not been commonly available until recently, so total serum calcium has been internationally corrected by the equation; corrected calcium=total calcium+(4-serum albumin), according to the report by Payne et al. However in their original study, serum ionized calcium had not been measured, and the relationship between serum total and ionized calcium had not been clarified. Therefore, we measured serum total and ionized calcium simultaneously in 86 maintenance hemodialysis patients, and investigated which calcium level more reflects ionized calcium; total or corrected calcium. The correlation coefficient between ionized calcium and total or corrected calcium was 0.896 and 0.861 before the hemodialysis. Hence serum total calcium better reflected ionized calcium than corrected calcium. More conveniently, one-eighth of total calcium value was precisely predictable for the ionized calcium level (r=0.896). We conclude that the calcium adjustment is not an essential procedure for estimating ionized calcium level.

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A 53-year-old male who had received hemodialysis for 15 years was referred to our clinic. This patient complained of hypertensive attack during the hemodialysis.
Transabdominal ultrasonogram, computerized tomogram (CT) and magnetic resonance imaging (MRI) demonstrated the presence of left adrenal tumor and bilateral multiple renal cyst with right renal solid mass. The size of the left adrenal tumor and right renal tumor were 8×5×4cm and 2cm in diameter, respectively. Left adrenal pheochromocytoma was confirmed by elevated serum norepinephrine level, and diagnosed by ¹³¹I-MIBG scintigram.
Left adrenalectomy and right nephrectomy were performed under general anesthesia. There was no evidence of malignancy in left adrenal pheochromocytoma, while the right renal tumor was pathologically diagnosed as renal cell carcinoma. The patient remains alive without any recurrence for 5 years and 6 months postoperatively. To our knowledge, this is the second case of adrenal pheochromocytoma and renal cell carcinoma associated with ACDK in a long-term hemodialysis patient in the Japanese literature.

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