[Aim] Althought the plasma refilling rate (PRR) during a hemodialysis (HD) session can be estimated by the CRIT-LINE^TM monitor (CLM), the optimal methods for measuring the PRR has not been established. Then, we investigate 11 methods for measuring the PRR to find an adequate and useful method. [Patients and Methods] Patients with stable blood pressure during HD participated in this study. Eleven methods of measuring the PRR using a combination of three patterns (UF-A, -B and -C) of ultrafiltration profile and a biometry method (8% method) and four kinds of recursion methods (Hct I method, ΔBV% I method, Hct II method and ΔBV% II method) for the effective blood volume (BV₍₀₎) at the start of an HD session were investigated. [Results] The PRR values were reflected in the three different ultrafiltration profiles. The PRR value obtained using the 8%-A method was 8.7±1.6mL/min. There was no significant difference between the PRR value obtained using the 8%-A method and that obtained using various BV₍₀₎ methods and the UF-C method. The PRR values measured using UF-B method were significantly lower than those measured using UF-A, or -C method (p<0.01, n=13). [Discussion] The PRR value obtained using the UF-A method is the value on ultrafiltration, while the PRR value obtained using the UF-B method is thought to be the physiological PRR. The UF-C method may be useful to determine the relationship between the colloid osmotic pressure and the PRR. The biometry method for obtaining the BV₍₀₎ showed an advantage for measuring the PRR throughout the HD session. [Conclusion] The 8%-A method is the best method for measuring PRR on ultrafiltration, and the 8%-B method is useful for measuring the PRR in the absence of ultrafiltration.

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The circumferential equipment and technology of haemodialysis (HD) have been remarkably improved over the past decade, which has been a great boon to HD patients. However, there are many HD complications that still must be overcome. In this study, we investigated nutritional assessment of 48 maintenance HD outpatients (Diabetic renal failure: 6 patients, Non-diabetic renal failure: 42 patients) using Buzdy's Prognostic Nutritional Index (PNI). On analysis, there was no correlation between PNI and either the gender or age of HD patients. Then, we divided the HD patients into three groups. One group had a 0-1-year history of dialysis (Group I), the second group had a 1-10-year history (Group II) and the third group had more than a 10-year history of HD (Group III). The mean value in Group I was 47.3±1.4 percent, Group II was 19.3±16.9 percent, Group III was 25.71±14.2 percent and there was a significant difference between PNI and HD history. However, there was no correlation between PNI and the optimal HD indicators of Kt/V and PCR. There was a correlations between PNI and both T·P and Albumin, but there was no correlation between PNI and the other factors that comprise Buzdy's equation. Furthermore, there was a significant correlation between PNI and daily energy intake of HD patients among Group II and Group III, but there was no correlation between PNI and daily protein intake. It is indispensable to maintain good nutritional status of HD patients in a bid to improve the survival rate and QOL, but even if we improve Kt/V and PCR, we cannot improve nutritional condition of HD patients. Our research strongly indicates that cachexia is a serious complication, especially among Group III patients.

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A 25-year-old male on maintenance haemodialysis for chronic renal failure caused by Alport's syndrome for 12 years with chronic pancreatitis had suffered from panic disorder since 1998. Therapy with paroxetine hydrochloride (PH) was commenced in December 2000 and a biochemical profile test showed significant increases of serum pancreatic enzymes on the 21st day of the administration of PH, although there were no symptoms or signs except for slight enlargement of pancreas detected by abdominal sonography and computed tomography. In May 2001 therapy with PH was stopped and rapid decreases of serum pancreatic enzymes followed. Therapy with trazodone hydrochloride (TH) instead of PH was then commenced, again resulting in marked increases of serum pancreatic enzymes; following discontinuation of therapy with TH the enzyme levels fell.
Sulpiride, which differs from SSRI, was then chosen as an alternative and no change of serum pancreatic enzymes has been found since the start of treatment with Sulpiride.
We suggest that acute exacerbation of chronic pancreatitis was caused by SSRI therapy in this patient.

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Treatment of resistant fungal peritonitis was evaluated based on the prevention of encapsulating peritoneal sclerosis (EPS). The patient was a 61-year-old man. In July 1997, CAPD therapy was started for the treatment of chronic renal failure derived from diabetic nephropathy. In February 2000, the CAPD therapy was discontinued because of the onset of fungal peritonitis, and the patient was transferred to hemodialysis. Daily peritoneal lavage and oral and/or intravenous administration of antifungal agents were added to the patient without removing the PD catheter. During the treatment symptoms such as abdominal pain and fever were not observed except for persistent cloudy effluent. The indwelling catheter was removed when the patient was hospitalized in August 2000. Thereafter, the peritonitis was cured, and EPS has not occurred.
Resistant fungal peritonitis is one of the risk factors that induce the occurrence of EPS, and cure of the fungal peritonitis is of primary importance. This case suggests that catheter removal immediately after the occurrence of resistant fungal peritonitis is more effective than repeated peritoneal lavage for the treatment, and that it might also be useful for preventing EPS.

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We describe a new technique by which the vessel is superficialized by endoscopic surgery to create vascular access in the arm.
First, a working tunnel is created just above the vessel in the arm. The length of the tunnel is about 25cm from a transverse incision in the antecubital region. After harvesting the vessel in the tunnel, it was pulled through the working tunnel. Then, a new route is created subcutaneously and the vessel is anastomosed to an artery in an end-to-side fashion in the antecubital region.
A study involving a larger number of patients and a longer follow-up are needed to evaluate the long-term results; still our new technique seems to be superior to conventional methods, because it is less-invasive, provides superior cosmetic results, and it is easy to puncture the access vessel even in the early postoperative periods.

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Gastric angiodysplasia is currently recognized as an important cause of gastrointestinal bleeding and its morbidity is relatively higher in renal failure patients than in normal subjects. Gastric antral vascular ectasia (GAVE) is a relatively rare type of angiodysplasia characterized by submucosal capillary dilatation and fibromuscular hyperplasia. The first case of GAVE has been documented by Jabbari in 1984.
We encountered three cases of hemorrhagic gastric angiodysplasia including a case of GAVE and these cases were successfully treated with argon plasma coagulation (APC).
Case 1: A 60-year-old woman who had been treated with CAPD for 7 years was hospitalized for severe anemia and epigastralgia. In March 1999, gastrointestinal fiberscopy (GIF) showed typical watermelon stomach that corresponded to GAVE. Case 2: A 52-year-old male who received CAPD since 1995 for CRF was hospitalized on February 1999 due to tarry stool and severe anemia (Hgb 3.7g/dL, Hct 11.2%). Vascular ectasia and oozing were identified in the antrum by GIF. Pathological determination proved angiodysplasia in the biopsy specimen obtained from the antral area. Case 3: A 51-year-old male had been receiving hemodialysis for uremia since 1981. On March 1998, a transjugular intrahepatic portosystemic shunt was established for portal hypertension induced by liver cirrhosis. Then, the patient was admitted urgently due to severe anemia and tarry stool in July 1999. Diagnosis of diffuse antral vascular ectasia was based on recognition of diffuse vasodilatation and oozing in the antrum on GIF. APC was successfully carried out in these three patients without any complication. In cases 1 and 2, deterioration of renal anemia was not demonstrated during the six-months observation period. Additionally, in case 3, frequency of blood transfusion was significantly decreased. We consider APC a safe and effective therapy for gastric angiodysplasia with intestinal bleeding in patients undergoing maintenance dialysis.

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