Cardiovascular disease, especially ischemic heart disease, determines the outcome of life expectancy in dialysis patients. For the correct and timely diagnosis and treatment of ischemic heart disease, disease background has to be clarified. Between Jan. 1998 and Dec of 2002, there were 125 dialysis patients with significant coronary artery stenosis diagnosed and/or treated by catheter or surgical intervention for the first time after initiation of dialysis therapy. All patients were admitted to our institution at the time of diagnosis. There were 95 males and 30 females patients with diabetes (DM) comprised 44%, those with glomerulonephritis (CGN) 38%, and hypertensive nephrosclerosis (NSC) 9%. NSC patients (70±10(SD) yrs) were older than CGN (61±9) or DM (62±9). Dialysis duration in NSC (2.2±2.3yrs) and in DM (4.0±3.8) were shorter than that in CGN (10.4±7.5: p<0.05 for both). Thus, in NSC and in DM, ischemic heart disease tends to occur early after the initiation of dialysis. In CGN, both short-term and long-term dialysis patients were noted and some had been on dialysis for more than 20 years. It is recognized that ischemic heart disease had occurred as a consequence of aging with long-term dialysis in these populations. Medical care providers should be aware that ischemic heart disease can occur at any time in dialysis patients as a whole. Understanding the disease background of ischemic heart disease in dialysis patients is also important.

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Little is known about the clinical characteristics of dialysis patients who developed uremic dilated cardiomyopathy (UDCM) defined as left ventricular (LV) enlargement and systolic dysfunction. We hypothesized overhydration as a potential cause of UDCM and therefore investigated the relationship between UDCM and the overhydrated state in chronic dialysis patients by using echocardiography. We studied 14 patients, 8 with hemodialysis (HD) and 6 with peritoneal dialysis (PD), who were diagnosed with UDCM (age 56±9 years, duration of dialysis 8.9±7.9 years). Among the former, 4 patients were treated by PD prior to HD. These 4 patients had normal LV function during PD treatment and showed UDCM during the first year after transfer to HD. We examined body weight at the initiation of dialysis therapy, the time when UDCM was diagnosed and the time of reassessed body weight. Additionally, LV end-diastolic and end-systolic dimension and % fractional shortening were measured by M-mode echocardiography. The body weight was increased by 3-10kg in 1 HD patient without the prior PD and all PD patients after the initiation of dialysis. LV end-diastolic dimension (62.4±5.2 vs. 54.6±7.3mm), LV end-systolic dimension (51.5±6.2 vs. 41.0±10.4mm) and % fractional shortening (17.6±5.0 vs. 25.9±9.4%) were significantly (p<0.01) improved by body weight reduction and/or medications described below. Body weight was successfully reduced (5.5±4.5kg) in all patients but 2 HD patients. Regarding medications, 4 patients were prescribed β-blocker, angiotensin-converting enzyme inhibitor or angiotensin II receptor antagonist after diagnosis of UDCM. We concluded that the inappropriate body weight management may contribute to the development of UDCM and the adjustment of body weight is therefore important for the prevention and treatment of UDCM.

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Background: Hemodialysis (HD) dose is well known to highly correlate with the prognosis of HD patients. However, the standard method, Kt/V requires a blood sample and subsequent calculation using a formula containing a natural logarithm, which might be tedious to some extent. Thus, determining the value might be inconvenient in emergency settings. We deduced that the product of body weight-normalized blood flow rate (Qb/BW) and treatment time (Qbt/10BW) could approximately equal single pool Kt/V. In the present study, we validated the deduction by a study of actual HD patients.
Methods: One hundred two HD inpatient at our hospital were studied. We collected the data from the medical records retrospectively. The correlation between Qbt/10BW and Kt/V was examined by simple regression analysis. The factors that affect the errors in estimating Kt/V were also examined by multivariate analysis.
Results: The comparison between Kt/V and Qbt/10BW indicated a close correlation: regression coefficient=1.070 (0.955-1.185), (R²=0.773, p<0.0001). Multivariate analysis showed that the difference between Kt/V and Qbt/10BW is influenced by Qb, post-HD body weight, and gender.
Conclusion: Although confounding factors exist in the estimation of Kt/V obtained by our new method, the present equation is easy to calculate and is useful especially in emergency settings or for the prescription of HD.

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We surveyed 1170 renal cell carcinoma (RCC) patients registered in the data bank of the Nara Uro-oncology Research Group and analyzed retrospectively the clinicopathological features and the outcomes of 35 dialysis patients with RCC who underwent nephrectomy. Twenty-seven patients were men and 8 were women. The mean age was 58.0±9.9(SD) years old. The mean dialysis duration until performing nephrectomy was 101.1±65.5 months. Twenty-seven patients were incidentally diagnosed and 8 patients presented with symptomatic RCC. Acquired renal cystic disease (ARCD) was found in 25 (71.4%) of the 35 patients. The number of RCC patient in each pathological stage was 23 in T1a, 6 in T1b, 4 in T3a, and 2 in T3b. The number of RCC patient with lymph node and distant metastasis was one in N1, 2 in N2 and 3 in M1. The number of RCC patient in each tumor grade was 9 in Grade 1, 21 in Grade 2, and 5 in Grade 3. The histopathological diagnosis was 16 clear cell carcinomas, 9 papillary RCCs, 4 granular cell carcinomas, 4 cyst-associated RCCs, and 2 chromophobe cell carcinomas. Six patients underwent adjuvant interferon therapy. One patient died of lymph node metastasis, one patient died of lung metastasis, and 5 patients died of other causes. The five-year survival rate was 79.4% in all patients 76.7% in ARCD patients, and 91.7% in non-ARCD patients. There was no significant difference in the prognosis between patients with and without ARCD. There was no significant difference in the 5-year overall survival rate in each tumor stage between dialysis and non-dialysis patients with RCC. ARCD did not influence the prognosis of dialysis patients with RCC, but the metastatic RCC resulted in a poor outcome in dialysis patients with RCC.

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A novel acute encephalopathy (AEP) occurred in many patients mainly living in the northern area of the Japan Sea-side in Japan between September and November 2004. Almost all patients had end-stage renal disease and/or ingested a species of mushroom, called Sugihiratake. Twenty-three cases of AEP were diagnosed in Akita Prefecture. Of these 23 cases, 16 patients were receiving maintenance dialysis, and we previously reported that ingestion of the mushroom and chronic hemodialysis were common factors in the 16 dialysis patients with AEP. To assess clinical risk factors for developing AEP, dialysis patients with AEP were compared to those without AEP using a mailed questionnaire. The questionnaire was mailed to 16 dialysis patients with AEP and 1, 674 dialysis patients without AEP. All 16 with AEP and 1, 236 of 1, 674 patients without AEP (73.8% in non-AEP) responded to the questionnaire. Two of 16 patients with AEP did not know whether they had ingested Sugihiratake or not, while the other 14 patients were aware of ingesting the mushroom. Of all 1, 252 dialysis patients, 573 patients (45.8%) had ingested Sugihiratake, 14 of these 573 patients (2.4%) had developed AEP. Of the 16 patients with AEP, 6 (37.5%) died of acute AEP.
None of the patients who did not ingest Sugihiratake developed AEP. The mean age, sex, dialysis duration, dialysis modality was not significantly different. By univariate analysis, the frequencies of diabetes mellitus (p=0.040, odds ratio 3.10) and ingesting Sugihiratake (p=0.010, odds ratio 8.63) were correlated with the occurrence of AEP in dialysis patients. These findings suggest that ingestion of Sugihiratake is a significant risk factor for developing AEP in dialysis patients. Further investigations are needed to identify the cause of AEP, probably due to a toxic substance contained in Sugihiratake.

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We report two hemodialysis patients who required treatment for hydronephrosis after total cystectomy. Case 1 complained of left lumbago due to huge hydronephrosis 10 months postoperatively. Percutaneous needle drainage under ultrasonography was performed. The drained urine was bloody but negative for cytology. Case 2 had residual tumor in the left upper urinary tract. One month postoperatively, he complained of severe left lumbago probably due to hemorrhage from the residual tumor, which required nephrectomy. These two cases imply the importance, of the indication of total cyctectomy with bilateral nephro-ureterectomy and of periodical check up for upper urinary tract after cystectomy, in hemodialysis patients.

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