Vascular anomalies due to occlusion or thrombosis of the inferior vena cava (IVC) may be hazardous for renal transplantation, and the preoperative vascular evaluation is important for a safe and successful surgery. This study assessed both the utility and the accuracy of two-dimensional time-of-flight (2D-TOF) magnetic resonance venography (MRV) as an alternative to conventional angiography for evaluating both the IVC and the iliac vein in potential pediatric renal transplant recipients. Four children with chronic renal failure were evaluated with 2D-TOF MRV by superior presaturation pulse and target maximum intensity projection. The whole MRV examination and filming required less than 30min. All 4 patients had a normal IVC and iliac vein. Two patients underwent renal transplantation, and the MRV findings were identical with the anatomy demonstrated intraoperatively. MRV is an accurate method for evaluating the condition of the IVC and iliac vein. It is a reliable, noninvasive and rapid technique that can be considered an alternative to invasive angiography for work-up in children scheduled for transplantation.

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Optimal flow rate of sodium bicarbonate substitute during acetate free biofiltration using Bifil-S^® as the dialysate was evaluated by change in blood flow rate and dialyzer membrane surface area. Serial serum sodium and bicarbonate concentration, as well as bicarbonate clearance were measured during treatment in six chronic hemodialysis patients, using two different surface areas of polysulfone dialyzer (1.3m² and 1.6m²), and changing blood flow rate as 100, 150, 175, and 200mL/min. Serial hematcrit was measured by CRIT-LINE^®, and other treatment conditions did not change. Flow rate of the substitute, in which the increase in bicarbonate concentration of over 25mEq/L at the end of treatment was not related to membrane surface area, it can be achieved at 12.5% to 13.5% of blood flow rate. However, serum sodium concentration was not changed during treatment, hematocrit was increased significantly in relation to ultrafiltration rate during treatment.
These results suggest that optimal flow rate of bicarbonate sodium substitute during acetate free biofiltration is 12.5% to 13.5% of blood flow rate.

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We have conducted high sodium hemodialysis (sodium concentration 152meq/L) to prevent a blood pressure drop induced by massive ultrafiltration. After conducting high sodium hemodialysis, the plasma sodium concentration was increased according to the dialysate sodium concentration obtained by a direct potentiometry. However, it did not change, or slightly decreased in some cases, compared to the starting hemodialysis plasma sodium concentration by indirect potentiometry. We, therefore, studied the causes of this difference in measurement values with direct and indirect potentiometry methods. A retrospective chart review during a 1-year period (January to December 2000) was done in 40 hemodialysis outpatients treated at our clinic. Items reviewed primarily consisted of the relationship between the amount of ultrafiltration, plasma total protein, and measured plasma sodium values by using both potentiometry methods. Over a 1-year period, differences between measurement values with the direct and indirect methods correlated with the rise of plasma total protein using hemodialysis ultrafiltrate (r=0.404, with p<0.001, n=468). These results suggest that measurement values using indirect methods are lower than that of the direct measurement. These values influenced solvent replacement (abnormal matrix) and that affected rising plasma total protein with hemodialysis ultrafiltration. If solvent replacement occurred, the measured sodium value apparently decreased. These results suggest that it is suitable for plasma sodium concentration measurements, which are conducted during high sodium hemodialysis, be obtained using direct potentiometry methods.

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Patients receiving hemodialysis (HD) often have severely calcified and diffuse stenosis in the coronary arteries. Recently, rotablator, which is a new device for percutaneous transluminal coronary angioplasty (PTCA), has been widely used for coronary artery disease. In this study, we evaluated the usefulness of rotablator in the treatment of coronary artery disease in HD patients. We analyzed early and late outcome of 78 hemodialysis patients (HD group) and 319 non-hemodialysis patients (non-HD group) with coronary artery disease who were treated with rotablator in our hospital between March 1997 and September 1999. There was no significant difference between the two groups in age, gender distribution, past history of diabetes mellitus, hyperlipidemia or myocardial infarction. The prevalence of hypertension among patients with HD was greater than that among non-HD patients. Otherwise, the patients in the non-HD group had more left anterior descending (LAD) lesions than those in the HD group. The initial success rate of this procedure was 94.7% in the HD group and 94.6% in the non-HD group. Regarding the results 6 months after the rotablator procedure, the rate of restenosis was 51.4% and 47.0% in the HD group and non-HD group, respectively. There was no significant difference between the two groups in the rate of cardiac accidents, a newly developed acute myocardial infarction and target lesion revascularization (45.3% vs. 44.9%). In conclusion, we demonstrated that rotablator is a useful tool for the treatment of coronary artery disease in patients with HD.

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Irinotecan hydrochloride (CPT-11), one of the anticancer agents that inactivate DNA topoisomerase I and inhibit DNA synthesis, has a strong antitumor activity in a broad spectrum of malignant tumors; however, the pharmacokinetics of CPT-11 has not been previously determined in hemodialysis patients with chronic renal failure.
We describe the pharmacokinetics and pharmacodynamics of CPT-11 in a 58-year-old patient on hemodialysis, who developed pulmonary and liver metastasis from colorectal cancer. After he and his wife were fully informed and gave consent, he received one dose of 80mg (50mg/m²) of CPT-11 as a 90-minute infusion. Hemodialysis was performed for 4 hours after administration. We measured the plasma levels of CPT-11 and metabolic products (SN-38, SN-38G) using HPLC at 0, 0.5, 1, 2, 4, 8, 12, 24 hours after the beginning of hemodialysis. At 0.5 hours, blood samples were collected at both the entrance and exit of the hemodialyzer, and samples of dialysate were also collected.
Single passage of blood through the hemodialyzer resulted in an approximate 50% reduction in CPT-11 and SN-38G concentrations with little change in SN-38 concentration. However, during the entire time course of dialysis, there were substantial reduction in the plasma concentration of CPT-11 and its metabolites. After hemodialysis, the extensions of half-lives of CPT-11 and its metabolites were observed as compared with those in patients with normal renal function. Chronic administration of a low dose (60mg/m²/week) of CPT-11 to a patient on regular hemodialysis was well tolerated and there was no evidence of toxicity.
In this case report, we show that the half-lives of CPT-11 and its metabolites was extended in a chronic hemodialysis patient.

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Encapsulating peritoneal sclerosis (EPS) is recognized as a severe complication in patients treated with continuous ambulatory peritoneal dialysis (CAPD). In most cases EPS develops several weeks to months after discontinuation of CAPD. Only a few cases of EPS were reported to develop between 3 to 5 years from the discontinuation of CAPD. In this report, we described a ESRD patient in whom EPS developed 11 years after the discontinuation of CAPD.
In 1985, a 56-year-old Japanese patient with ESRD started to receive CAPD. During 5 years of CAPD treatment, he developed peritonitis only once. In 1990, CAPD was discontinued and after that he was treated by maintenance hemodialysis. In December 2001, he was admitted to our hospital because of severe abdominal pain, vomiting and appetite loss, and a diagnosis of ileus was made. Stenosis was detected by a small bowel series, therefore synechotomy was performed. Not only stenosis of the small bowel but also intestine covered by thick peritoneum was found, so this case was considered EPS.
This case suggested that EPS could develop even 10 years after the discontinuation of CAPD. We need to consider the possibility of EPS in the differential diagnosis of a patient with acute abdomen, who has a history of peritoneal dialysis.

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We describe the effect of combined therapy of hemodialysis and ascites dialysis in a chronic renal failure patient with liver cirrhosis and refractory ascites.
The patient was a 77-year-old woman who had been diagnosed as liver cirrhosis due to hepatitis C hepatitis 10 years ago. She had been diagnosed with chronic renal failure one year ago and received conservative treatment. She was admitted to our hospital to start hemodialysis because uremic symptoms and severe anemia were observed. An arterio-venous fistula was constructed utilizing the left radial artery and left cephalic vein, and an Abdominal Port (SMAP-27; Nipro) was implanted simultaneously in the subcutaneous tissue, inserting a catheter through the abdominal cavity into Douglas' cul-de-sac. A twenty-gauge needle was injected into the port and removed ascites by an extra pump during hemodialysis. Ascites, after condensed and dialyzed by another hemopump, was re-infused into the arterial chamber side of the blood circuit. Hemodialysis continued for 30 to 60 minutes. As a result, serum total protein level rose from 4.6g/dL to 6.0g/dL. After starting treatment, she because able to take an adequate meal because the sense of full stomach disappeared, and her daily activity improved. No notable side effect was found and systemic hemodynamics remained stable.
It is suggested that ascites dialysis facilitates removal of hepatic and renal toxins from ascites by ultrafiltrating and dialyzing, and controls water balance and body weight without causing hypotensive episodes. Compared to classical paracentesis, SMAP-27 is found to be a useful and safe device because it is easily punctured into abdominal cavity. Her symptoms by ascites was reduced, thus, enhancing the patients' activity and quality of life.

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