Renal anemia accompanied with hemodialysis (HD) patients is thought to originate chiefly from a relative decrease in erythropoietin production and additionally red blood cell (RBC) osmotic fragility. However, there have only been a few reports about the effect of HD on RBC osmotic fragility. In this study, we measured RBC osmotic fragility in 12 HD patients before and after HD, and pre and post dialyzer one hour after starting HD. To evaluate RBC osmotic fragility, samples of RBC from each patient were incubated in NaCl solutions ranging from 0.1 to 0.85% and the NaCl solution at which 50% of RBCs were lysed was considered the median osmotic fragility (MOF). The results showed that MOF after HD was significantly decreased compared to that before HD (MOF before HD : 0.41±0.01, after HD : 0.38±0.01%, p<0.01). Furthermore, there was a significant positive linear correlation between MOF before HD and the dose of recombinant human erythropoietin (rHuEPO: IU/week), and erythropoietin resistance index (ERI) (rHuEPO: r=0.62, ERI: r=0.58, p<0.05, respectively). However, there was no difference between pre and post dialyzer-MOF. Thus, HD can improve RBC osmotic fragility and RBC osmotic fragility may be influenced by decreased reactivity of erythropoiesis stimulating agent. Moreover, improvement of RBC osmotic fragility was not immediately obtained by RBCs passing through the dialyzer.

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There are regional differences in the outcome of dialysis; however, few studies have investigated the causes. We stratified 122 factors by gender and by 47 prefectures and then investigated which factors are associated with regional differences in the incidence of dialysis treatment, the survival of dialysis patients, and the number of specialists by univariate analysis. The database used was JRDR-09105 maintained by the Japanese Society for Dialysis Therapy. This database includes 102,011 patients starting dialysis in Japan during 2004-06. The number of daytime/night dialysis institutes, the number of specialists, the number of hospitals, the average duration of hospitalization, the average annual temperature, the lowest temperature, total hours of sunshine, the percentage of elderly people living alone, the interval between the first hospital consultation and initiation of dialysis, intake of meat, dietary fat intake, (positive correlation), general population over 65 years old, days of rain, duration of the snow season, the number of family members, mortality rate from malignant tumors, cerebrovascular disease, and many nutritional factors (negative) were associated with the incidence. A history of brain hemorrhage (positive) and blood urea nitrogen after dialysis (negative) were correlated with the 1-year survival rate in both genders. Numbers of full-time nurses and dietitians were also correlated with 1-year survival rate (positive). The number of dialysis specialists was associated with the incidence of dialysis, 1-year survival, protein catabolic rate, Kt/V, dialysis time, number of daytime/night dialysis institutions (positive), and blood creatinine after dialysis (negative). Many factors, including the number of dialysis specialists, were associated with the incidence of dialysis and with survival.

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We report a rare case of autosomal dominant hereditary disorder, May-Hegglin anomaly characterized by a triad of giant platelets, thrombocytopenia and leukocyte inclusion bodies. This disorder is caused by mutations in the the gene MYH9 encoding the nonmuscle myosin heavy chain-A (myosin IIA), and the MYH9 mutation is considered to play an important role in the pathogenesis of Alport-like symptoms (sensorineural deafness, cataracts and nephritis). A 45-year-old woman was admitted to our hospital with complaints of general malaise and frequent vomiting. On gastric endoscopic study, there was no sign of ulcer formation and she was diagnosed as having Mallory-Weiss syndrome. Laboratory data demonstrated decreased platelets counts (4.4×10⁴/μL), giant platelets and inclusion bodies in leukocytes on May-Giemsa staining. Blood chemistry showed extremely elevated serum creatinine level (33.39mg/dL) and hemodialysis therapy was initiated. In the family history, her daughter had been diagnosed as having MHA in her childhood and her father had been treated with maintenance hemodialysis therapy and died at the age of 46. Audiogram of the patient showed sensorineural hearing impairment at a high frequency range in the bilateral ears and cataracts were observed in the bilateral lenses on ophtalmological examination. MYH9 gene analysis of patient showed that heterozygous E1841K mutation was observed in exon 38. Immunofluorescence analysis of myosin IIA showed abnormal localization of myosin IIA in the cytoplasma of neutrophilic granulocytes. Based on these data, we diagnosed this patient as having May-Hegglin anomaly complicated by Alport-like symptoms.

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In the field of ophthalmology, fluorescein angiography is essential for diagnosing chorioretinopathy and evaluating treatment response. In a 44-year-old female with diabetic nephropathy receiving hemodialysis, hemorrhage of the ocular fundus was suspected, and a fluorescence contrast medium (Fluorescite for intravenous injection, 500mg or less, fluorescein) was employed. When performing dialysis after contrast enhancement, the fluorescent color of the contrast medium was visually confirmed in the drainage tube for dialytic fluid. Using a color scale that we prepared, we examined the kinetics of contrast-medium removal for 1 week based on changes in the drainage color. The color scale values were 90/50 at the start/completion of observation on Day1, 20/10 at the start/completion of observation on Day3, and 0/0 at the start/completion of observation on Day5, respectively. However, the fluorescent color of the contrast medium was faintly observed in dialytic fluid collected in a 500mL bottle at the end of the dialysis session on day5.

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