In the present study, to determine whether glycohemoglobin (HbA1c) and glycoalbumin (GA) levels accurately reflect the glycemic state of diabetic patients receiving hemodialysis (HD), we measured HbA1c and GA in diabetic patients on HD (HD-DM, n=16) and those without HD (nonHD-DM, n=16) and examined the correlation between these indices and seven point capillary blood glucose profiles (mean blood glucose profiles). In addition, we measured HbA1c levels in subjects with normal glucose tolerance with HD (HD-nonDM, n=85) and compared these values with those measured in normal subjects (nonHD-nonDM, n=170). The mean HbA1c level in HD-nonDM (4.4±0.5%), was significantly lower than that in nonHD-nonDM (4.9±0.3%).
The same was true in the DM groups (5.7±1.3% in HD-DM vs 8.1±2.3% in nonHD-DM) under the condition of their respective mean blood glucose profiles (182.8±44.3 vs 217.2±65.4mg/dL). In comparison to a significant correlation between HbA1c levels and mean blood glucose profiles in nonHD-DM (r=0.92), the correlation was much weaker in HD-DM (r=0.45).
In contrast to the poor correlation between these indices in HD-DM, GA levels were significantly correlated with mean blood glucose profiles in this group (r=0.53), though the coefficient of correlation was smaller than that in nonHD-DM (r=0.91). Based on the findings described above, we can conclude that HbA1c levels in diabetic subject on HD are reduced despite their glycemic states and are only weakly correlated with their actual condition, comparing to those in non-HD diabetics. However, GA levels can be an alternative marker for evaluating diabetic control in these patients.

View full abstract

Questionnaires were sent to hemodialysis units in February 2000 to determine the current incidence of renal cell carcinoma among chronic hemodialysis patients. The response rate was 69.8%. Renal cell carcinomas were detected in 399 hemodialysis patients (320 males and 79 females) between March 1998 and February 2000. The mean age of these patients was 56.1±10.7 (mean±SD) years, and the mean duration of hemodialysis was 132.8±85.8 months. The clinical diagnosis was based on screening in 88.0%, and only 23 cases (5.8%) were symptomatic. Acquired renal cystic disease was found in 304 of 380 renal cell carcinoma patients (80.0%). Fifty-seven (15.0%) of 379 patients had metastasis. The classification of renal cell carcinoma (n=287) based on the General Rule for Clinical and Pathological Studies of Renal Cell Carcinoma (1999) was clear cell carcinoma in 141 cases (49.1%), granular cell carcinoma in 62 cases (21.6%) and papillary renal cell carcinoma in 54 cases (18.8%). In conclusion, this questionnaire survey of renal cell carcinoma in dialysis patients demonstrated the largest numbers of renal cell carcinoma and cancer characteristics similar to those on previous questionnaires. It is noteworthy that 52.3 percent of 392 renal cell carcinomas were detected in patients who had undergone hemodialysis for more than 10 years.

View full abstract

Purpose: We compared complications and prognosis of patients on maintenance hemodialysis due to complications of diabetes mellitus (DM) with those of dialysis patients with chronic glomerulonephritis (CGN) or hypertensive nephrosclerosis (HT). Methods: We retrospectively reviewed 92 patients who had received to maintenance dialysis between January 1991 and December 1995 in our hospital. These patients were divided into three groups by the etiologies of end-stage renal disease (ESRD); DM group (n=26), CGN group (n=49), HT group (n=17). The complications and the prognosis of these patients after initiation of dialysis therapy were compared. Results: Ischemic heart disease and arteriosclerosis obliterans (ASO) were more frequent in the DM group than in CGN and HT groups. The survival rate was significantly lower in DM and HT groups than in the CGN group. In all groups, prognosis was poorer in cases complicated by heart failure, cerebral vascular disease, severe infection or malignant neoplasm. In the DM group, poorer prognosis could be predicted by the presence of ASO. Conclusion: Cardiovascular complications were more frequent in the DM group. ASO was the most important factor related to poor prognosis in the DM group.

View full abstract

We performed a single center study comparing Thoratec^® Vascular Access Graft (TVAG) and Expanded Polytetrafluoroethylene Graft (Gore-tex^® Stretch vascular grafts, E-PTFEG) with respect to the patency. Sixty-one patients (TVAG 38, E-PTFEG 23) were enrolled in this study. Gender distribution, mean age, duration of dialysis, rate of complication by diabetics or cardiovascular disease did not significantly differ between the two groups. At 6 and 12 months, primary patency rates were 75.4% and 59.2%, respectively, in the TVAG group and 73.7% and 57.3%, respectively, in the E-PTFEG group. At 6 and 12 months, secondary patency rates were 94.3% and 75.4%, respectively, in the TVAG group and 87.0% and 66.7%, respectively in the E-PTFEG group. There were no significant differences between the two groups in primary and secondary patency rates. The interval between surgery and first use of the graft was 15.1±3.8 days in TVAG and 19.9±5.0 days in E-PTFEG. TVAG could be punctured earlier than E-PTFEG (p=0.003). We concluded that graft patency of TVAG was similar to that of E-PTFEG. When dialysis patients are immunocompromised, appropriate prophylaxis of infection induced by TVAG is necessary. TVAG also has disadvantages such as frequent kinking when implanted over elbow joints.

View full abstract

The patient was a 71-year-old male, who has been under hemodialysis since January 1996. He complained of gross hematuria in March 1997. The serum level of PSA was 37.2ng/mL and histological examination revealed well differentiated adenocarcinoma of the prostate gland. Clinical stage was determined as T2a. Following hormonal therapy for 8 months, the patient was treated with radiotherapy. Total 70Gy/35 fractions/58 days using 120 degree bilateral arc rotation radiotherapy was administered to the prostate. The patient complained of bilateral hip joint pain since April 1999 and was diagnosed as having bilateral old femoral neck fractures in June 2000. The serum PSA value has remained below 0.5ng/mL since May 1998. Radical prostatectomy is inevitably accompanied by massive bleeding in case of hemodialysis patients. Prostate carcinoma is difficult to completely cure by hormonal therapy. We consider that radiotherapy is a suitable treatment for patients on hemodialysis with clinical stage T1/T2 prostate cancer.

View full abstract

Thrombocytopenia is one of the complications in the use of heparin associated with acute thrombosic events. We report here a case of heparin-induced thrombocytopenia in a patient treated with hemodialysis. Progressive thrombocytopenia with clot formation in the A-V fistula occurred in a 56-year-old diabetic man after the onset of hemodialysis treatment using heparin. After we substituted nafamostat mesilate for heparin as an anticoagulant, the platelet count began to recover. After acetyl salicylic acid (ASA) 0.33g p.o. was coadministered with heparin instead of nafamostat mesilate, thrombocytopenia never occurred. Heparin-induced thrombocytopenia was suspected and the anti-PF4-heparin complex antibody was found to be strongly positive. We propose that it may be productive to study the possible contribution of this disease to idiopathic thrombocytopenia or thrombosis.

View full abstract