A nationwide statistical survey of 3, 932 dialysis facilities was conducted at the end of 2004 and 3, 882 facilities (98.73%) responded. The population undergoing dialysis at the end of 2004 was 248, 166, an increase of 10, 456 patients (4.4%) from that in 2003. The number of dialysis patients per million was 1, 943.5. The crude death rate of dialysis patients from the end of 2003 to the end of 2004 was 9.4%. The mean age of patients who underwent dialysis in 2004 was 65.8 years, and that of the total dialysis population was 63.3 years. The percentage distribution of patients who underwent dialysis according to the underlying disease showed that 41.3% of patients had diabetic nephropathy and 28.1% had chronic glomerulonephritis.
The rate of calcium carbonate usage for hemodialysis patients was 75.1% and that of sevelamer hydrochloride usage was 26.2%. The rate of sevelamer hydrochloride usage does not necessarily have a strong correlation with the dose of calcium carbonate. Patients, who received a high dose of sevelamer hydrochloride tended to have a low concentration of arterial blood HCO₃- approximately 15% of hemodialysis patients used an intravenous vitamin D preparation, which was generally maxacalcitol. The longer the patients had been on hemodialysis, the higher the frequency of use of an intravenous vitamin D preparation. When the concentration of blood serum intact PTH was more than 200 pg/mL, the frequency of use of an orally administered vitamin D preparation decreased; instead, that of intravenous vitamin D preparation increased.
The percentage of hemodialysis patients who received percutaneous ethanol injection therapy (PEIT) in the facilities surveyed was 1.4%, and it was particularly high for patients who had been on hemodialysis for more than 10 years. The percentage of patients who again received PEIT was 35.0%. The percentage of patients who had been on hemodialysis for more than 10 years and again received PEIT was more than 50%.

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Introduction: Splenectomy is usually required before ABO-incompatible living-related renal transplantation (LDRTx). We evaluated the surgical outcomes of laparoscopic splenectomy in our department to determine whether laparoscopic splenectomy for ABO-incompatible LDRTx is safe and effective.
Materials and Methods: Until the end of June 2005, a total of 704 patients underwent LDRTx in our department including 52 patients with ABO-incompatible LDRTx. Between April 2001 and June 2005, we performed laparoscopic splenectomy in 21 hemodialysis patients for the pretreatment of ABO-incompatible LDRTx. Under general anesthesia, surgery was performed by lateral approach. We evaluated surgical outcomes, i.e., surgical duration, amount of blood loss, efficacy and complications.
Results: The mean surgical duration was 131.7±45.8 minutes and the mean blood loss was 193.0±505.8mL. Blood transfusion was required in only one patient in this series. In this patient, conversion from laparoscopic approach to open surgery was required because of massive bleeding and the serum amylase level was elevated postoperatively. The patient was postponed RTx. All cases had satisfactory kidney function after LDRTx and developed no kidney graft failure due to acute rejection. Almost all patients could walk the day after laparoscopic splenectomy and were satisfied with their cosmetic appearance after wound scar.
Conclusion: Laparoscopic splenectomy is a safe, effective and less invasive surgical procedure for pretreatment of ABO-incompatible LDRTx.

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Background: We recently reported the usefulness of combination therapy with selective PEIT and intravenous maxacalcitol for secondary hyperparathyroidism (SHPT). However, few studies have compared the same combination therapy with that of selective PEIT and oral calcitriol pulse therapy. In this study, we compared the effectiveness of selective PEIT+intravenous maxacalcitol to that of PEIT+conventional oral calcitriol pulse therapy.
Methods: The study subjects were 10 patients on hemodialysis (6 males and 4 females, age; 56.0±17.8 years, HD period 11.8±3.8 years, mean±SD), with a high intact-PTH level (>400pg/mL) and 1 or 2 enlarged parathyroid glands detected by power Doppler ultrasonography. Five patients received PELT+oral calcitriol pulse therapy and the other 5 received PEIT+intravenous maxacalcitol therapy. Informed consent for PEIT was obtained from each patient. The effects of the two combination therapies were monitored by measuring intact-PTH, serum Ca and P, Ca×P, bone metabolic markers, parathyroid gland volume and bone mineral density, prior to and at 6, 12 and 18 months post-PEIT.
Results: Successful control of intact-PTH, bone metabolic markers and parathyroid gland volume was achieved by both combination therapies. However, PEIT+intravenous maxacalcitol, but not PEIT+oral calcitriol pulse therapy, resulted in significant falls in serum P and Ca×P product.
Conclusion: For SHPT, the combination therapy of selective PEIT and intravenous maxacalcitol is more potent for the control of serum P and Ca×P product than the combination of PEIT and oral calcitriol pulse therapy, though both produce equivalent suppression of PTH.

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We studied the attitudes of hemodialysis patients toward their treatment; the status of self-care, eating and drinking patterns, sense of support, methods of coping with stress, and perspectives on life. The subjects were 110 hemodialysis patients who gave informed consent after receiving an explanation of the concept of the study.
Factor analysis was conducted by using items on a category-based questionnaire. We selected items whose factor load was 0.40 or higher for only one factor. Using these subscales, principal component and cluster analyses were conducted, and patients were classified into one of four behavioral pattern groups: “idealist”, “indifferent”, “pseudo-adjusted”, and “desperate”. Patients in the “pseudo-adjusted” group showed good selfmanagement in terms of body weight control, and therefore, we supposed that their problems were easily overlooked. Many exhibited signs of internal struggle and behavioral problem, suggesting that they are considered to be the priority patients who need the support from the perspective of mind-body medicine.

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About 25 years have passed since continuous ambulatory peritoneal dialysis (CAPD) was introduced in Japan. The time is ripe for reviewing PD procedures. In this regard, a questionnaire was sent out to physicians and nurses at 63 institutions in the Tokyo area where PD patients are treated to investigate self-management, PD technique and regularty of testing.
Thirty-two (50.8%) physicians and 37 (58.7%) nurses completed and returned the questionnaire. At the time of bag replacement, 100%, 100%, 97.0%, 81.8%, 9.1% and 6.1% of the institutions instructed the patient to wash their hands, wear a mask, close the window, stop air-conditioning, lock the door and wear a hair cap, respectively. As for the draining method, 75.7% and 13.5% of institutions encouraged complete drainage and time-limited drainage, respectively. As for self-measurement every day/every time, 100%, 100%, 91.9%, 86, 5%, 73.0%, 54.1%, 43.2%, 43.2% and 24.3% of the institutions instructed the patients to record the drainage volume, fluid removal volume, body weight, blood pressure, infusion volume, water content balance, urine volume, pulse rate and body temperature, respectively. Regarding care of the outlet port, 100%, 100%, 94.6%, 94.6%, 86.5%, 81.1%, 62.2%, 37.8%, 5.4% and 2.7% of the institutions instructed the patients to wash their hands, fix the catheter to the abdomen, care for the site every day, protect the outlet port, close the window, wear a mask, stop air-conditioning, protect the titanium adapter, lock the door and wear a hair cap, respectively. Patients were allowed to take shower from 30.6±25.5 days (median 25.5 days) and a bath from 36.7±26.2 days (median 30.0 days) after the start of PD. As for the washing method, 29.7%, 13.5%, 13.5% and 5.4% of the institutions instructed the patients to “wash lightly with soap and then shower off well”, “wash carefully with soap and then shower off well”, “use only the shower to wash off well” and “use only the shower to wash off lightly” respectively. Regarding catheter replacement, 100%, 100% and 91.9% of the institutions instructed those performing replacement, caregivers and patients, respectively, to wear a mask, and 16.2%, 15.2% and 5.4% of the institutions, respectively, instructed them to wear a hair cap. During catheter replacement, 97.3%, 70.3% and 16.2% of institutions instructed them to close the window, stop air-conditioning and lock the door, respectively. Concerning the frequency of regular tests, there was not much difference among the institutions in the frequency of blood and biochemical tests, abdominal echography, abdominal & cardiac echography, fecal occult blood test, endoscopy of upper digestive tract, funduscopy, bone density test or peritoneal membrane equilibrium function test. However, considerable differences were observed among the institutions in the frequency of chest X-ray, KUB, electrocardiography and optimal dialysis index determination (urine accumulation).
It is necessary to review the contents of self-management, PD technique and regular tests, which currently differ among institutions, in order to provide better medical care and nursing for patients as well as to establish a satisfactory medical care regimen.

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We used carbon dioxide (CO₂) as a negative contrast material for blood access evaluation in patients with a history of severe allergic reaction to iodinated contrast material. PTA with CO₂ was performed 23 times in a total of six patients. In one patient, we also compared blood vessel diameter by using CO₂ with that by IVUS. Two patients underwent PTA with only CO₂. Three patients who had previously been examined with iodine contrast media were given CO₂ and the previously obtained X-rays were used as a reference.
All six patients were successfully examined with CO₂. Before expansion of stricture 1, CO₂ was judged to be 11.1% wider than that shown by IVUS. After expansion of stricture 1, and before and after stricture 2, CO₂ was judged to be 2.2% to 47.4% narrower than that shown by IVUS. In a normal diameter of non-thrombotic occlusion of balloon choice department, 6.4% CO₂ was evaluated (overestimated) much wider than IVUS. In addition, at a normal diameter of stricture 1.2 of balloon choice department, 6.3% CO₂ was evaluated, being underestimated, much narrower than IVUS. Within 10% of overestimation, there were no problems arising from balloon choice. In case of insufficient expansion due to underestimation, PTA by CO₂ is possible if a larger diameter balloon is chosen.
CO₂-PTA is possible since the balloon size selection error is small, less than±6.4%.

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A 90-year-old female with chronic renal failure and sequela associated with cerebral infarction was admitted to our hospital. After about 8 years (May 21, 1998), she complained of general fatigue and anorexia. She was unable to eat orally due to gradual loss of appetite. Thereafter, she developed with severe dehydration. Subsequently, total parenteral nutrition (TPN) was initiated on May 27, 1998. Five days later, she developed acute pneumonia and mixed acidosis accompanied by hyperkalemia. After 12 days, she showed hyperchloremic metabolic acidosis, laboratory findings demonstrated normal plasma anion gap (AG), normal aldosterone levels, lower transtubular potassium gradient (1.36), urinary AG level of 22.4mEq/L, and reduced serum creatinine levels (decreased from 1.8mg/dL on May 26, 1998 to 0.9mg/dL on June 8, 1998). Drug therapy and peritoneal dialysis led to improvement of hyperkalemia and hyperchloremic metabolic acidosis; however, she died 18 days later due to aggravation of acute pneumonia.
Based on these conditions, she was diagnosed as having hyperkalemic renal tubular acidosis (hyperkalemic RTA). We speculate that acute metabolic acidosis was caused by TPN, which reduced aldosterone responsiveness in the collecting tubule cells of the kidney, leading hyperkalemic RTA.

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