We investigated the efficacy of reducing the serum β₂-microglobulin (β₂M) level with a single treatment of the newly developed β₂M-adsorbing column Lixell S-25 for patients with dialysis-related amyloidosis (male : 42, female : 41), as well as the incidence of adverse events. The dialysers used in the combination were of four types ; type III : 10.2%, type IV : 68.0%, type V : 20.5%, and others : 1.3%. After dialysis was performed with the Lixell S-25 column, the β₂M level was decreased significantly from 25.5mg/L to 7.5mg/L (71% of the baseline value). In addition, six patients were treated in a crossover fashion, in the first period, using S-35 and in the second using S-25. This sequence of treatment yielded β₂M clearances of 84.3mL/min and 78.0mL/min, respectively. Adverse events occurred in 8/83 patients (9.6%), and the major adverse event was hypotension. In two patients treated with the S-15, there was no hypotension while hypotension did occur when the S-25 was used. In conclusion, the S-25 exhibited a high rate of β₂M reduction, comparable to the S-35. The frequency of adverse events on short-term observation was less than that with the S-35, and similar to that with the S-15.

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Recent promotion of information technology in the medical field has led to the institutional use of electronic medical records for patient information management and sharing of patient information among departments. A number of sites operating such systems, including institutions involved in dialysis care, have implemented dialysis management systems through electronic access to medical records. Our hospital has also established such a system and introduced a clinical path for dialysis. Here, we assessed the usefulness of linking our dialysis management system to electronic medical records. We performed a questionnaire survey among 12 staff members regarding the usefulness of paper records before implementation of an electronic dialysis management system, and on that of a computerized system at 3 and 12 months after implementation of the system. The efficiency of issuing and receiving instructions from physicians through the use of electronic medical records 3 and 12 months after implementation of an electronic dialysis management system was rated lower and higher than that of paper records, respectively. The effectiveness of drug control, item control and coordination with other in-house departments at 3 and 12 months after electronic system implementation was rated higher than that of paper records. In contrast, staff ratings did not indicate a significant difference in the efficiency of post-hemodialysis briefing to ward staff 3 and 12 months after electronic system implementation compared to that using paper records. Performing operations using a dialysis management systems involving electronic medical records is generally considered more effective than using paper due to the convenience of computerization. As tasks become more complex, however, sufficient acclimation with the system to allow comfortable operation takes a significant amount of time. In addition, although smooth interaction between electronic medical records and dialysis management systems cannot be achieved at the present time, we anticipate that system improvements will arise in the near future.

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At the start of hemodialysis, we usually choose the arterio-venous fistula (AVF) at the tobacco fossa for the primary vascular access. In this study, we examined the factors determining vascular access selection at hemodialysis onset. There were 94 patients who started hemodialysis in 2003 and 2004. Arterio-venous fistula was selected as the primary access in 85% of patients. Among those who were not considered fit for AVF construction, there were 10 patients with low cardiac function, and 8 patients lacking appropriate vessels for fistula construction. In patients with low cardiac output, subcutaneous superficialized brachial artery was chosen for vascular access. They continued to receive stable hemodialysis for a comparably long period. All 4 patients who underwent subcutaneous cuffed catheter placement died within 29 months ; however, catheter infection was not the cause of death in any of these patients. Subcutaneous cuffed catheter appeared useful for debilitated elderly patients who could not tolerate upper arm surgery, or did not have veins suitable for blood return or an artery of good quality for direct puncture. Selection of vascular access when starting hemodialysis depends on such factors as low cardiac function, arteriosclerosis and deterioration of forearm veins as well as aging.

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Objective : The cause of fever in hemodialysis patients is sometimes difficult to diagnose. We investigated whether there were differences between the causes of fever in hemodialysis patients and non-hemodialysis chronic kidney disease (CKD) patients, which was not diagnosed in outpatient examinations or at another hospital. Materials and Methods : We conducted a retrospective chart review of 100 CKD patients who were admitted to our hospital to investigate the cause of fever between August 1998 and April 2007. We classified the patients according to CKD stage and compared the causes of their fever as determined by a thorough examination. Results : The cause of the fever was infection in 29 of the 42 hemodialysis patients, malignancy in 2, hemodialysis-related amyloidosis in 6, and drug-associated in 1, and the cause remained unknown in 4. None of their fevers was caused by collagen disease. On the other hand, the cause of the fever was infection in 39 of the 58 stage1 to 5 patients, collagen disease in 9, malignancy in 3, and drug-associated in 1, and it remained unknown in 6. Collagen disease was a less common cause of fever in hemodialysis patients than in the stage1 to 5 patients (0% versus 18.4%, p=0.0094). The duration of hemodialysis in patients with hemodialysis-related amyloidosis was 23.1±5.0 (16-29) years. Of the 29 patients in whom the cause of fever was infection, 2 were shown to have tuberculosis based in the results of Gaffky and/or culture and/or the polymerase chain reaction, but none of the other stage patients was found to have tuberculosis. Conclusion : Infection should be considered when investigating the cause of fever in hemodialysis patients, because it is the most frequent cause and because delayed treatment is associated with increased mortality. Tuberculosis and amyloidosis should also be considered.

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[Background] Hemodialysis patients with arteriosclerosis obliterans received alprostadil (Palux^®, Liple^®) by intravenous administration upon completion of the dialysis session. [Objectives and Methods] To study the pharmacokinetics of alprostadil during dialysis, we assessed the ability of different dialysis membranes (PS, PMMA, and PEPA membranes) to adsorb and filter alprostadil based on absorbance changes using a simulated dialysis circuit. [Results] While there was no adsorption or filtration with the PS membrane, the alprostadil removal rates by adsorption with PMMA and PEPA membranes were 8% and 5%, respectively ; and the removal rates by filtration with these membranes were 53% and 8%, respectively. [Discussion] These findings indicate that alprostadil can be administered to dialysis patients with arteriosclerosis obliterans at any time during or after dialysis using an PS membrane. In those using either a PMMA or PEPA membrane, however, alprostadil should be administered upon completion of the dialysis session because these membranes adsorb alprostadil.

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The patient was a 53-year-old woman on maintenance dialysis. High plasma renin activity (PRA) and high plasma aldosterone concentration (PAC) were noticed by chance, and she was closely examined. PAC was very high, 40,080pg/mL. A right adrenal tumor was thought to be an aldosterone-producing adenoma with renovascular PRA increase. Right adrenalectomy was performed and the PAC value decreased. It was thought that negative feedback did not occur because the factor controlling PAC secretion decreased, and easily reached a high value, although there is an example in which extremely high aldosterone developed due to renal failure. Moreover, it is necessary to assess whether there is a material that interferes the PAC measurement system in maintenance dialysis patients, and to evaluate it carefully.

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