Purpose: Calcium supplementation is required early after parathyroidectomy (PTx) because of the remarkable decrease of serum calcium levels. We administered calcium supplementation during hemodialysis treatment to prevent hypocalcemia after PTx. Thirty-six patients underwent parathyroidectomy between January 2002 and July 2003. These 36 patients consisted of the group (14 patients) receiving intravenous drip injection of calcium gluconate in a ward, and the treatment group (22 patients) who received calcium gluconate during hemodialysis session using the hemodialysis route. The frequency of drip infusion therapy was significantly decreased in the treatment group. Furthermore, several complications such as pain and swelling caused by calcium gluconate injection were decreased compared with those in the control group. The levels of serum calcium were rapidly increased and stabilized during the hospital stay. We conclude that calcium supplementation during hemodialysis promotes an earlier increase in serum calcium levels after parathyroidectomy. In addition, the patients experienced fewer complications related to intravenous injection of calcium gluconate.

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Most hemodialysis patients have non specific untreated complaints that are suggested to relate to changes in various inflammatory cytokines. Recently, complementary and alternative medicine (CAM) has been increasingly applied to problems that remain unresolved by Westernized medicine. In this study, we evaluated the clinical effect of a traditional herbal formula, Juzen-Taiho-to, on the quality of life (QOL) and changes in plasma inflammatory cytokine levels in hemodialysis patients. The subjects were 29 patients receiving maintenance hemodialysis (20 males and 9 females, 62±12 years of age with an average dialysis period of 54±48 months). Juzen-Taiho-to was administered for 4 weeks. The plasma levels of interleukin-1 beta, interleukin-6, tumor necrosis factor alpha, and serum C-reactive proteins were measured. The kidney disease quality of life Short Form (KDQOL-SF^TM) was utilized to asses the patient's QOL. The administration of Juzen-Taiho-to decreased the plasma TNF-α level (pre vs. post=5.5±2.5 vs. 4.2±2.5pg/mL; p<0.01), and significantly improved “Lack of appetite” and “Washed out or drained” scores on the KDQOL-SF^TM (1.9±1.3 vs. 1.6±1.0; p<0.05, 2.4±1.2 vs. 1.8±0.8; p<0.05, respectively). In patients with a high KDCS score before administration of Juzen-Taiho-to (n=15), the Juzen-Taiho-to-induced decrease in the plasma TNF-α level was more remarkable (pre vs. post=5.6±2.7 vs. 3.5±1.2pg/mL; p<0.01) and correlated well with the improvement in the fatigue score (r=0.492, p<0.05) compared to those in low KDQOL patients (n=14). Thus, treatment with Juzen-Taiho-to as one type of CAM improved, at least in part, the QOL of patients on maintenance hemodialysis by an inhibitory effect on the plasma TNF-α level.

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To establish preventative measures for encapsulating peritoneal sclerosis (EPS) in patients on peritoneal dialysis (PD), an understanding of the primary pathophysiological mechanism of EPS risk factors such as high transport state is crucial. A new computer program, PD NAVI (JMS, Japan) which incorporated two models, that of Pyle-Popovich's and the three-pore model, can provide calculated data of peritoneal transport profiles. This paper reports the analytical results obtained with PD NAVI in stable PD patients, and presents the characteristic features in high transporter patients. One hundred PD patients were subjected to PD NAVI test, and the following parameters were calculated; unrestricted pore area over diffusion distance: area, relative hydraulic conductance of cell pore (aquaporin): rLpS (C), small pore: rLpS (S), large pore: rLpS (L), lymph flow, and index for peritoneal diffusive selectivity (IPDS). According to the patients classification by peritoneal equilibration test (PET), each parameter was compared. Patients were classified as follows by PET; low transporter in 2, low average in 36, high average in 45 and high in 17 patients. There were significant differences in the following parameters among the groups; rLpS (C), rLpS (S), lymph flow, and IPDS. Significant lower levels were found in rLpS (C) and IPDS, while lymph flow and rLpS (S) were significantly higher in the high transporter group compared to those in high average and low average patients. The result of PD NAVI analysis showed that decreased aquaporin and increased cellular gap and lymphatic absorption contributed to the primary mechanism of a high transport state. Whether those changes are involved in the risk of EPS awaits further study.

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Carpal tunnel syndrome (CTS) in long-term haemodialysis patients is caused by haemodialysis amyloidosis. Because of this pathogenesis, the symptoms are progressive and spontaneous recovery does not occur. In these patients, surgical treatment is required. We have performed endoscopic carpal canal release using the Universal Subcutaneous Endoscope (USE) system since 1986. With our minimally invasive procedure, we can achieve optimal results in haemodialysis patients as well as those with idiopathic cases. In haemodialysis patients, however, continued maintenance haemodialysis causes further deposition of amyloid and the recurrence rate of carpal tunnel syndrome in such patients is five percent. We divided patients who received primary endoscopic carpal canal release and were followed for more than six months into two groups, a recurrent group and a nonrecurrent group, then compiled and statistically analyzed the mean age at primary surgery, mean duration of haemodialysis, incidence of bilateral CTS and arterio-venous shunt side. There were significant differences in mean age and mean duration of haemodialysis between the two groups. In haemodialysis-related CTS, the surgical procedure should be minimally invasive because of the possibility of recurrence. Therefore, our endoscopic procedure should be the first treatment choice for long-term haemodialysis patients with CTS.

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Since a new occurrence of hepatitis infection in patients undergoing hemodialysis treatment may be due to nosocomial infection, its prevention is an important task. Patients who are newly prescribed hemodialysis are likely to move from the original hospital to another satellite hospital for maintenance hemodialysis. This suggests that even if strict standard precautions are maintained in one hospital, it would be useless if other institutes do not maintain such precautions as well. Kasugai Municipal Hospital is a primary hospital facility in Kasugai city and performs this function by initiating hemodialysis. Thereafter, patients transfer to a satellite hospital or receive emergent rescue according to the hospital network. Based on this background, we designed a prospective survey of the development of new hepatitis infections over a one-year period in a collaborative study among 6 cooperating hospitals. There were 634 patients enrolled in this study, with 98 patients newly starting hemodialysis. There were 105 transfers between 7 hospitals and 28 patients died during the study period. Fortunately, there were no new hepatitis infections during this survey. Though the duration of our survey was short, it suggests that nosocomial hepatitis infection is preventable by the strict observance of established protocols to prevent the spread of nosocomial infection as well as education to the staff.

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A 61-year-old man with chronic renal failure undergoing maintenance hemodialysis was admitted for arteriovenous access thromboses. Piperacillin (PIPC) was administered after surgical fistula revision. Severe hemolysis was developed after 12 days of this surgery. Hematocrit decreased from 26.1% on admission to 13.8%. Laboratory findings were consistent with autoimmune hemolytic anemia (AIHA) except for negative direct Coombs'test. Although PIPC and other drugs were discontinued anemia did not abate. Oral prednisolone was initiated based on a diagnosis of Coombs-negative AIHA and five days later, the hematocrit rose to 28.4%. Using an immunoradiometric assay (IRMA), IgG on the red cells was quantitated. Eventually, we diagnosed drug-induced Coombs-negative AIHA, for which low dose prednisolone was very effective. There have not been any recurrences for 9 months while on tapered doses of prednisolone.

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