A nationwide statistical survey of 4,098 dialysis facilities was conducted at the end of 2007, and 4,052 facilities (98.88%) participated. The number of patients undergoing dialysis at the end of 2007 was determined to be 275,242, an increase of 10,769 patients (4.1%) compared with that at the end of 2006. The number of dialysis patients per million at the end of 2007 was 2,154. The crude death rate of dialysis patients at the end of 2007 from the end of 2006 was 9.4%. The mean age of new patients introduced into dialysis was 66.8 years and the mean age of the entire dialysis patient population was 64.9 years. For the primary diseases of new patients introduced into dialysis, the percentages of patients with diabetic nephropathy and chronic glomerulonephritis were 43.4% and 23.8%, respectively. The percentages of facilities that achieved the control standard of endotoxin concentration in the dialysate solution of less than 0.05 EU/mL and that achieved a bacterial count of less than 100 cfu/mL in the dialysate solution, which are specified by the Japanese Society for Dialysis Therapy, were 93.6% and 97.4%, respectively. The percentage of patients positive for the HCV antibody among the entire dialysis population significantly decreased from 15.95% at the end of 1999 to 9.83% at the end of 2007. The mean hemoglobin concentration in all the dialysis patients at the end of 2007 was 10.27 (±1.32, s.d.) g/dL, which scarcely changed over the last three years. The numbers of male and female patients with a history of femoral neck fracture were 142.9 and 339.0 per 10,000 dialysis patients, respectively, showing an extremely high rate among female patients. A history of femoral neck fracture correlates with low body mass index, serum albumin concentration, and a history of diabetes. The serum creatinine level of patients upon introduction to dialysis was 8.34 (±3.55) mg/dL and the estimated glomerular filtration rate was 5.43 (±3.43) mL/min/1.73 m² for the patients who were newly introduced into dialysis in 2007.

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Sensitivities to five basic tastes of sweet, salty, sour, bitterness and umami taste were examined before and after hemodialysis in 67 (38male, 29female) hemodialysis patients (HD) who regularly attended the Onoyama clinic. The whole mouth method and LMS scale (Labeled Magnitude Scale) were used. The concentrations of each taste solution were 1gust, 10 gust. Taste sensitivity for bitterness in HD was higher after HD compared with that before (p<0.05). As for sensitivities to other tastes, there were no significant differences after dialysis. The sensitivity of patients less than 65 years old was greater than that of patients 65 or more years old for saltiness and umami taste (p<0.05). Regarding the relationship between gender and taste sensitivity, sensitivity in females was greater compared with that in male for sweetness, saltiness and sourness (p<0.05). The serum zinc levels showed low values overall, and there was hardly a correlation with each taste sensitivity. In this study, the sensitivity to bitterness increased after dialysis in comparison with taste sensitivities before dialysis. These findings suggest that dialysis has a marked influence on maintaining function of the taste.

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Purpose : To evaluate the usefulness of PainVision^® PS-2100 as an indicator of sensory nerve dysfunction, the current perception threshold (CPT) was examined in hemodialysis (HD) patients. Patients and Methods : HD patients at Juntendo University were recruited in this study and 61 HD patients (male 36/female 25) and 112 normal controls (male 52/female 60) were enrolled. CPT was evaluated before and after HD therapy. Results : The CPT levels in HD patients were significantly higher than those in normal controls. Before HD therapy, CPT levels in the hand in which arteriovenous fistula was created (shunt side) were significantly higher compared with those in the opposite hand (non-shunt side) (pre HD ; shunt side : 14.7±5.8μA, non-shunt side : 12.3±4.4μA, p<0.0001). The CPT levels before HD therapy both on the shunt and non-shunt side of male patients were significantly higher them those in female patients (shunt side ; male 16.6±6.1μA, female 12.0±4.1μA, p<0.002, non-shunt side ; male 13.4±4.5μA, female 10.7±3.7μA, p<0.02). The CPT levels after HD therapy were significantly decreased both on the shunt and non-shunt side (shunt side, pre HD : 14.7±5.8μA, post HD : 13.4±6.5μA, p=0.04, non-shunt side, pre HD : 12.3±4.4μA, post HD 10.6±3.2μA, p<0.002) than those before HD therapy. Before HD therapy, there was no significant difference in the CPT level on either the shunt or non-shunt side on a comparison between diabetic and non diabetic patients. Age, gender and presence of chronic renal failure were identified as independent risk factors for CPT levels on multivariate regression analysis. Conclusion : It appeared that measuring CPT level regularly using PainVision^® PS-2100 would be useful to detect the early stage of sensory nerve dysfunction.

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For quality control during dialysis fluid manufacture, it is important to ensure patient protection by monitoring bacterial contamination and taking measures to prevent accidents. When high sensitivity is required to monitor bacterial contamination, the membrane filtration (MF) method is desired. In this study, we evaluated the MF methods (37mm Quality Monitor and MicroFunnel^TM SP Filter Unit (Nihon Pall Ltd. Pall Life Science Company, Tokyo, Japan)) with the culture media of R2A/TGE agar or broth. We compared the MF methods with the plate count methods based on bacterial colony numbers from both MF methods about the measurement accuracy of bacteria that exist in dialysis fluid using two standard microorganisms (Pseudomonas fluorescence, Methylobacterium extorquens) and one wild type isolated from the dialysis fluid in our clinic. As a result, all data of the MF methods showed more than 70% bacterial recovery on the basis of each bacterial colony number for Pseudomonas fluorescence (59.3cfu/plate), Methylobacterium extorquens (62.5cfu/plate) and Wild type (38.6cfu/plate) on R2A plate agar. In conclusion, the MF methods that were evaluated in this study may be an effective tool for quality control during the dialysis fluid production process.

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Dementia has been reported to be one of causes of bleeding accidents during hemodialysis. This study clarified bleeding accidents in dementia patients after completion of hemodialysis. Between 2003 and 2007, hemodialysis was performed on 225 patients (including 128 inpatients) at Sanai Memorial Soga Hospital. Bleeding occurred 17 times in 15 patients (10%) among 145 patients without dementia while 84 bleeding episodes occurred in 29 patients (36%) among 80 patients with dementia indicating that bleeding occurred more often in patients with dementia (χ² test, p<0.001). Of 101 bleeding episodes in this period, bleeding occurred 43 times during hemodialysis and 58 times after hemodialysis. Medical accidents involving massive bleeding occurred once during hemodialysis in a dialysis unit and 8 times after dialysis in inpatients with dementia in wards and one of these accidents was fatal. All massive bleeding accidents occurred in dementia patients who did not call nurses when bleeding began. This study indicates that dementia is the major cause of bleeding accidents and medical staff must carefully monitor these patients even after hemodialysis.

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A 62-year-old Japanese man had been started maintenance hemodialysis due to diabetic nephropathy two years earlier. High inflammatory reaction persisted, and he developed high fever that did not respond to several antibiotics. Although there was no superficial lymphadenopathy during the clinical course, chest computed tomography showed enlargement of mediastinal lymph nodes. Whole-body positron emission computerized tomography demonstrated multiple foci of intense FDG uptake in the mediastinal lymph nodes. Evidence of Mycobacterium tuberculosis infection could not be obtained from sputum or urine specimens either by staining for acid-fast bacilli or with a polymerase chain reaction specific for tuberculosis (TB), or by culture. Although there was no history of TB, tuberculin-positive reaction and QuantiFERON^® TB-2G (QFT) were positive. Since an increase in tumor markers, was also detected thoracoscopy mediastinal lymph node biopsy was performed, in order to differentiate mediastinal lymph node TB from lung cancer and malignant lymphoma. The specimen showed pathologic findings typical of Mycobacterium tuberculosis infection, with epithelioid granuloma including the multinucleate giant cell. Four anti-tuberculous combination therapies (INH, RFP, PZA, and SM) were initiated. After treatment, fever subsided, inflammatory response decreased. Although, TB is important as a cause of fever of unknown origin, a high rate of extrapulmonary TB in dialysis patients makes it more difficult to diagnose. Not only diagnostic imaging and organization diagnosis, but also serologic diagnosis QFT is useful for the diagnosis of TB in dialysis patients.

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This report describes a 72-year-old male who was initiated on hemodialysis in January 2006 because of chronic renal failure (original disease unknown). Following coronary artery bypass grafting (CABG) and mitral valve replacement (MVR), the patient was found to have diminished cardiac function, and was, therefore, initiated on hemodiafiltration ; however, during the procedure, marked hypotension occurred and the patient developed intradialytic symptoms. Therapy was thus changed to acetate-free dialysis (acetate-free biofiltration, or AFB) in August of the same year, but the patient showed sporadic premature ventricular contractions (PVCs) during dialysis and also hypotension, with persistence of the intradialytic symptoms. After medication for tachycardia, the patient required a backup pacemaker ; since he also had diminished cardiac function, a widened QRS duration and ventricular tachycardia (VT), implantation of an implantable defibrillator with dual-chamber pacing (cardiac resynchronization therapy defibrillator, or CRT-D) was deemed indicated. CRT-D implantation was conducted on September 15, 2006, with cardiovascular improvement being noted following the dual-chamber pacing. Echocardiography demonstrated improvement of the left ventricular diastolic diameter (LVDd), left ventricular mass (LVM) and cardiac function. The intradialytic hypotension and difficulty in ambulation decreased and VT also ceased to appear, allowing consistent dialysis.

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