Malposition of the peritoneal dialysis catheter causes infusion-drainage difficulty over time. For such a catheter malposition, we previously reported the utility of a simple method (Peritoneal Wall Anchor Technique: PWAT) of inserting a nylon thread and fixing the catheter on the abdominal wall using a laparoscope system. However, there was a problem that half of these cases involve emergency procedures, and that we must use laparoscope system to manage or prevent catheter malposition. Therefore we think that prevention is more important than managing, catheter malposition after it has occurred and report PWAT as a method to be performed during catheterization. These methods are able to approximately resolve the risk of complications such as bowel perforation by puncturing from the abdominal cavity to the body surface instead of puncturing from body surface. Using this method, we treated 21 patients without any complications. This method appears to be useful, simple and safe.

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Background: The huge mass effect caused by enlarged polycystic kidneys with or without polycystic liver is one of the most important prognostic factors in patients with end-stage renal disease caused by autosomal dominant polycystic kidney disease (ADPKD). Although open surgical treatment has been considered as the best treatment for such patients, Ubara et al., Toranomon Hospital, recently reported that interventional procedures by renal transcatheter arterial embolization (TAE) markedly decreased the renal size in ADPKD patients, relieving their symptoms. This paper investigated the prevalence and outcomes of these procedures for ADPKD patients at other hospitals in Japan. Methods: In July 2004, questionnaires were sent to 18 Japanese hospitals that had reported treating ADPKD with renal TAE. The response rate was 60% (12 hospitals) and 34 cases were accumulated and analyzed. Results: Among 34 patients, 25 patients underwent bilateral-renal and 9 patients unilateral TAE. The embolization materials were intravascular coils with or without spongel in 30 patients, ethanol with or without spongel in 3 and only spongel in one. Main complications were fever and pain. Other complications included “coil nearly dropping in to the aorta” and “vascular access occlusion”. Twenty-one of 22 receiving bilateral renal TAE showed improvement of symptoms. Abdominal circumference was significantly decreased by -6.9±4.8cm (n=13, p<0.001) compared with baseline values before therapy and renal volume decreased to 60.4±16.0% (n=21, p<0.0001) more than 6 months after TAE. Unilateral renal TAE was also effective in 7 patients, but was not effective in 2 patients in whom the volume of the untreated kidney increased rapidly compared with baseline values before therapy (141.2%, 138%). Conclusions: Renal TAE for enlarged polycystic kidneys in ADPKD patients was effective and bilateral renal TAE is recommended.

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Sleep disordered breathing (SDB) has been recognized as a common complication in dialysis patients. However contributing factors have not been fully evaluated. Therefore, we examined the relationship between clinical parameters and SDB in dialysis patients.
One hundred and one dialysis patients [hemodialysis 99, peritoneal dialysis 2, mean age 64.3 years, male 51: female 50, dialysis period 4.8 years, diabetes mellitus (DM) 40.6%, body mass index (BMI) 22.4] were screened for SDB with pulse oximetry and Epworth Sleepiness Scale (ESS) as well as clinical parameters. Polysomnography (PSG) was added in 42 patients with 3% oxygen desaturation index (3%ODI) more than 5 or with ESS more than 11. SDB was classified as mild (5≤3%ODI<15), moderate-severe (15≤%ODI) according to the results of pulse oximetry.
Among 101 patients, 52 patients (51.5%) were identified as SDB (mild: 34.7%, moderate-severe: 16.8%) with pulse oximetry and 11 patients (10.9%) showed more than 11 points of ESS. PSG examination demonstrated a high prevalence (28.9%) of central SDB compared to general population (3-5%). In moderate-severe SDB patients, levels of hematcrit and hemoglobin were significantly lower than those in normal and mild SDB patients (Fig). More severe SDB were found in DM patients and patients with enlarged cardiothoracic ratio. However, other clinical parameters such as interdialytic weight gain, blood urea nitrogen, creatinine were not significantly different in normal, mild and severe SDB.
The present study confirmed the high prevalence of SDB in dialysis patients and multiple factors may influence severity of SDB.

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We examined differences in the phosphorus concentrations in renal diets between those calculated using the “Standard Table of Food Composition in Japan” (5th revised edition) and those determined by actual measurements.
Thirty-six recipes were randomly chosen from certain card-style recipes, for renal diets, available on the market in Japan, and these recipes were used to prepare test samples of diets.
The measurement of the amount of phosphorus in a meal was made with Molybdenum blue absorptiometry, and with Inductively Coupled Plasma Optical Emission Spectrometry (ICP). Then, these measured values were compared with those calculated by using the Standard Table.
1. The results showed that the measured value of phosphorus concentration was 294.1±60.5mg (mean±SD) per meal, while the calculated value was 227.7±28.8mg per meal in terms of thirty-six sample diets. There was a significant difference between values obtained using these two methods (unpaired t-test p<0.005). 2. The ratios of the measured values to the calculated values of phosphorus concentrations in meals ranged from 0.55 to 2.72. The mean ratio of the measured values to the calculated values was 1.30±0.53 (median: 1.18). Fifty percent of all sample diet demonstrated ratios greater than 1.2. 3. The measured value of phosphorus in three combined meals for 30g, 40g, 50g, and 60g-protein diets (for twelve days, altogether) exceeded 700mg. 4. With regard to the cooking style used for meal preparation, 73% (11 of 15 meals) of Western style meals resulted in ratios (measured/calculated values of phosphorus contents) greater than 1.0, followed by Japanese style: 69% (11 of 16 meals), and Chinese style: 60% (3 of 5 meals). 5. We confirmed that values of phosphorus concentrations measured by Molybdenum blue absorptiometry and ones measured by ICP methods were highly correlated (r=0.964, p<0.05).
As the Standard Table compiles one standard value per one food item, variety of circumstances in which foodstuffs are produced, such as growing/breeding fields, soil, species, fertilizer/livestock feed, or climate, results in differences between actually measured values of particular foods and calculated values based on the Standard Table.
This study indicates the degree to which these two values differ in terms of phosphorus in 36 sample diets. Thus, it is suggested that we must perform multiple assessments when counseling patients on nutritional intake.

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We examined the influence of hemodialysis membranes on the serum 1-3-β3-D-glucan level. Seventy-two outpatients on maintenance HD without infections were enrolled in this study. Thirty-three patient were treated with regenerated cellulose (CL-EE12N by Terumo Corporation), 14 with cellulose triacetate (FB-70 by Nipro Corporation), 20 with polysulfone (BS-1.3 by Toray Medical Corporation) and 5 with EVAL (KF-15C by Kuraray Corporation). After obtaining informed consent, serum 1-3-β-D-glucan concentrations were measured before and after HD. Serum 1-3-β-D-glucan levels were extremely high in patients treated with regenerated cellulose (649±435pg/mL, n=33) as compared to those in patient treated with cellulose triacetate (13±9pg/mL, n=14) or synthetic high molecular membrane (26±13pg/mL, n=25) (p<0.0001, respectively). Serum 1-3-β-D-glucan levels were slightly higher than normal (<20pg/mL) in patients treated with synthetic high molecular membrane. When regenerated cellulose was used, the serum 1-3-β-D-glucan level increased after HD (from 649±435pg/mL to 1, 091±833pg/mL) (p<0.01). In contrast, when cellulose triacetate or synthetic high molecular membrane was used, the level did not change. Serum 1.3-β-D-glucan levels were positively correlated with HD duration in patients treated with regenerated cellulose (r=0.605, p=0.0005). When patients are hemodialysed with regenerated cellulose, it is difficult to diagnose mycotic infection by using 1-3-β-D-glucan. When patients are being hemodialysed with a synthetic high molecular membrane, careful consideration is required.

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Objective: To investigate the results of surgery, preoperative and postoperative complications related to the spinal surgery for hemodialysis patients were evaluated. A total of 78 hemodialysis patients who underwent spinal surgery (51 men, 27 women) and a total of 77 non-hemodialysis patients who underwent spinal surgery (52 men, 25 women) were subjected. Methods: We evaluated the followings; preoperative and postoperative complications, surgical duration, intraoperative and postoperative bleeding, surgical outcome expressed as the JOA (Japan Orthopaedic Association) score and improvement rate (Hirabayashi method), mortality within 3 months. Results: There was no difference in surgical duration, intraoperative bleeding, and postoperative bleeding between two groups. There were more preoperative and postoperative complications in hemodialysis patients than non-hemodialysis patients. The main postoperative complications in hemodialysis patients were fever, bleeding from the digestive organ, and hypotension. Preoperative and postoperative JOA scores of cervical surgery in hemodialysis patients were lower than those in non-hemodialysis patients (p=0.002, p=0.02). However there was no difference in the improvement rate (p=0.49). About lumbar surgery, there was no difference in preoperative and postoperative JOA score, and improvement rate (p=0.26, 0.20, 0.37).
Improvement rate did not differ between hemodialysis patients with hemodialysis duration of more than 20 years and those with less than 20 years (p=0.74, 0.99: cervical, lumbar) when compared in a group of stage 1, 2 (classification by Maruo) and a group of stage 3, 4 (p=0.62, 0.06: cervical, lumbar). Two hemodialysis patients died within 3 months. Conclusions: Our results of spinal surgery for hemodialysis patients was favourable. Cooperation with other department as well as a management in intensive care unit is required. It is necessary to prepare for spinal surgery including management in an intensive care unit.

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