Intravenous iron preparations and rHuEPO are important in the treatment of anemia in hemodialysis patients. It is generally considered that all intravenous iron preparations are the same in terms of effect. However, we have found differences between saccharated ferric oxide and cideferron. Specifically, a larger than anticipated increase in serum ferritin was observed with a dose reduction in the iron preparation and rHuEPO. In this study, three iron preparations (saccharated ferric oxide, cideferron, iron chondroitin sulfate) were administered for one year each for a total of three years to 86 patients undergoing chronic dialysis, and various parameters (Ht, Hb, iron preparation dose, serum ferritin, MCV, rHuEPO dose) during each treatment period were compared. The same patients were used throughout the study. Each week, the rHuEPO dose for the following week was determined in accordance with our established dosage nomogram based on hematocrit (Ht) value. Iron dose was based on ferritin concentration, measured monthly. It was shown that the mean Ht concentration was maintained at about 30% during the 3-year period, with the highest levels were observed during treatment with cideferron. During this period, hemoglobin levels were also the highest and a significant increase in serum ferritin as well as increased mean corpuscular volume (MCV) were observed. To maintain the ferritin concentration, cideferron required the lowest dose. During treatment with cideferron, the rHuEPO dose was significantly lower than that during treatment with saccharated ferric oxide but the same as that during treatment with iron chondroitin sulfate. In summary, despite administering a lower dose, cideferron was most effective in increasing serum ferritin. Since the increase in serum ferritin coincided with a decreased rHuEPO dose, we concluded that a definite increase in serum ferritin levels could be achieved by rHuEPO dosage reduction.

View full abstract

Adequacy of dialysis is very important for the dialysis patient. Vascular access is one of the most important factors influencing the quality of dialysis ; sufficient blood flow is needed and there must not be re-circulation. There are few reports investigating the concrete conditions under which re-circulation appears. Therefore, we investigated 1) the influence of distance between puncture sites and puncture direction on the appearance of re-circulation, 2) the relation between vascular access flow and re-circulation. Thirty-seven dialysis patients were selected for this study. Using a dialysis monitor, HD02^®(Transonic Systems company, NY, USA), we measured vascular access flow and re-circulation rate, and examined the correlation among the re-circulation rate, puncture needle distance and puncture direction. We also examined minimum vascular access flow in the absence of re-circulationn. In this study, we demonstrated that re-circulation never appeared when the distance between the puncture sites was more than 30mm, but did not depend on puncture direction, when fair vascular access was achieved without stenosis and showed limited branching with a blood flow over 700mL/min. In addition, when distance between the puncture sites was 50mm in case of the opposite puncture, re-circulation appeared with vascular access flow less than 300mL/min. There was no improvement in the re-circulation rate even if blood flow was reduced by 20% (Q_B250→200mL).

View full abstract

Japan Erythropoietin Treatment (JET) Study was carred out to evaluate the relationship between maintenance of Hb levels and patient prognoses after the first application of epoetin beta formulation (Epogin) to new hemodialysis patients. Using data collected up until June 2007, we examined the baseline characteristics of patients on the first day of hemodialysis and the status of anemia treatment 3 months later. As a result, it was noted that many patients demonstrated some cardiovascular histories or complications and the mean Hb level at introduction to hemodialysis was relatively low compared to that in Europe or the US.

View full abstract

We present a 50-year-old female patient with multicentric Castleman's disease. Since the patient had chronic renal failure of unknown etiology, hemodialysis therapy had been performed twice a week for eight months until she was admitted to our hospital. She had shown mild fever, lymph node swelling, and general fatigue for two years, and biochemical tests showed high levels of CRP, IL-6, HTLV-1 antibody, and polyclonal hypergammaglobulinemia. Lymph node biopsy showed idiopathic plasmacytic lymphoadenopathy, and renal biopsy demonstrated tubulointerstitial nephritis. Based on these data, we diagnosed the patient as having multicentric Castleman's disease along with renal dysfunction associated with Castleman's disease. DFPP (double-filtration plasmapheresis) and prednisolone therapy were started. After those therapies, renal function improved and hemodialysis therapy was finally discontinued. We should reevaluate hemodialysis patients with renal failure due to unknown etiology.

View full abstract