The effect of wiping skin instantly after application of 10% aqueous povidone-iodine (PI) was studied in 12 subjects and compared to the effects of 0.05% chlorhexidine (CH). These agents were topically applied once at the blood access site, then wiped with aseptic gauzes after up to 15 seconds (instant wipe method) before needle insertion. When PI was used, there were no bacterial colonies detected on the skin cultures from eleven of 12 sites. When CH was used, the colony counts were reduced after each procedure; however, viable bacteria were absent in only one of 7 sites. PI showed a significantly stronger disinfecting effect than in the CH based on this method (the odds rate 66, 95% confidence interval [3.5-1254]). These results suggested that PI with instant wipe method could be a safe procedure for inserting needles for blood access.

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Previous studies suggested that cancer antigen 125 levels (dCA125) in peritoneal dialysate could be a marker of mesothelial cell mass in stable peritoneal dialysis (PD) patients. We evaluated longitudinal changes of dCA125 in a total of 70 PD patients. The duration of observation was 34±15 months. Every 6 months, dCA125 was determined from effluents during a 4-hour dwell using 2.5% glucose dialysates. There was no relationship with the duration of PD and no significant changes in dCA125 over 3 years were found in 21 patients who had just started PD or in 11 patients whose duration of PD was 5 years or longer. A significant decrease in dCA125 was demonstrated after peritonitis episodes in 26 patients (23.2±12.1→9 months later 14.4±8.4U/mL, p<0.05). In 6 patients who developed encapsulating peritoneal sclerosis after discontinuation of PD, dCA125 significantly decreased in the final 2 years of PD (21.7±8.8→9.0±4.6U/mL, p<0.05). These results suggest that dCA125 remains longitudinally stable in PD patients. A decrease in dCA125 was found in some PD patients with peritonitis episodes or development of peritoneal sclerosis. However, interindividual variability exists and it is difficult to find significant changes in dCA125 associated with these clinical outcomes in PD patients.

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For dialysis patients who show sudden hemodynamic changes during treatment, continuous monitoring of blood pressure would be useful to improve management. However, the standard oscillometric measurement fails to deliver such continuous monitoring. In this study, we evaluated a new computer algorithm (harmonized alert sensing technology; HASTE) employed in the monitoring instrument, Moneo BP-88si (Colin Corporation, Aichi, Japan). By continuously analyzing electrocardiogram and plethysmogram, HASTE can continuously estimate the blood pressure as estimated systolic blood pressure (Esys) between actual measurements (non-invasive blood pressure; NIBP) obtained by the standard oscillometric method. On detecting a potential hemodynamic change in Esys, HASTE automatically initiates measurement of NIBP (HASTE triggering function).
We applied HASTE in 5 dialysis patients who were admitted to our intensive care unit and undergoing invasive systolic blood pressure (Isys) monitoring by an intra-arterial catheter. By comparing Esys by HASTE with Isys, a strong correlation (r=0.81±0.07) was found between the two parameters. Regarding the triggering rate in HASTE, it successfully initiated blood pressure measurement with a sensitivity of 85.7% and a specificity of 84.6%. Furthermore, there was a significant correlation between changes in Esys and Isys during periods from NIBP measuring points to HASTE triggering points (r=0.62, p<0.01). These findings indicate that HASTE is a useful option for detecting sudden changes in blood pressure during dialysis sessions.

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A 69-year-old man on maintenance hemodialysis (HD) due to chronic glomerulonephritis, was admitted to our hospital because of consciousness disturbance. On admission, he showed semicoma, conjugate deviation of the eyes to the left, and horizontal nystagmus. Computed tomography and angiography of the brain was performed, but there were no findings that could explain his manifestation. Laboratory findings reflected systemic inflammation and disseminated intravascular coagulation. After HD on the day of admission, he developed severe hypoglycemia and needed frequent intravenous injection of glucose solution. His consciousness and general condition did not improve and he died the next day. Pathological anatomy demonstrated vegetation of the mitral valve consisting of gram positive bacteria, and also manifested bacterial embolisms of systemic organs including the brain particularly in the bilateral cerebellums. He was diagnosed with infectious endocarditis, and his nervous symptoms were proven to have been caused by micro-bacterial-embolism of the brain. Severe hypoglycemia was thought to have been induced by sepsis. Sepsis rarely induces hypoglycemia to adults, unless the patient has a metabolic glucose disorder in his background, such as liver cirrhosis, chronic renal failure or other conditions. We should note that sepsis is one of the main cause of hypoglycemia in HD patient.

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Advanced peritoneal dialysis catheter tip translocation leads to difficulty in infusion and drainage, body weight gain and so on. Additionally, the catheter function will be completely lost by involving the omentum. Thus, it is sometimes inevitable that catheter extraction and reinsertion, or switch to hemodialysis. Therefore, catheter shape and α replacement therapy have been devised for prevention/therapy for catheter tip translocation. However, its effect on advanced catheter tip translocation was limited.
Herein, we report a laparoscopic peritoneal wall anchor technique (PWAT) for peritoneal catheter tip translocation. This is a method of fixing the catheter downward in the peritoneal cavity after inserting a fixed stitch through a cannula from the body surface under laparoscopic assistance. In this method, suture in the peritoneal cavity and consequent insertion of a suture needle or scissor forceps into the peritoneal cavity is unnecessary. In other words, this method does not require any special equipment, so that it can be performed both simply and safely. Moreover, it offers the advantage of allowing extraction of the catheter without intra-abdominal surgery, if the catheter extraction should be required.
We report two cases in this article. One involved preventive treatment in a newly introduced patient with intra-abdominal adhesion due to previous intra-abdominal operation. The other involved an intractable case, in which α replacement therapy had been performed twice without improvement of catheter tip translocation.

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A 64-year-old male with end-stage renal disease who had been on hemodialysis since March 2000 was referred to us after abdominal ultrasound screening demonstrated a right renal mass. The patient had a past history of right partial nephrectomy for renal hemorrhage 45 years before. CT and MRI showed bilateral atrophic kidneys with cysts (acquired cystic disease of the kidney: ACDK) and a renal tumor of 4cm in diameter in the lower pole of the right kidney. However, it was difficult to differentiate renal cell carcinoma from hematoma by diagnostic imaging. The patient underwent right radical nephrectomy under a preoperative diagnosis of suspected renal cell carcinoma of ACDK. The pathological diagnosis of the surgical specimen was intra-cystic hematoma (hemorrhagic cyst). Most of the reported cases of renal hematoma in patients on hemodialysis were complicated with ACDK, and could easily be distinguished from renal cell carcinoma by CT and MRI. Image findings in this case were considered very rare. Because of the high rate of renal cell carcinoma complicated with hematoma and also of the high incidence of renal cell carcinoma in ACDK, we chose radical nephrectomy in this case.

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