Catheter-related bloodstream infection (CRBSI) is the most critical complication in patients with hemodialysis catheters. To investigate agendas and therapeutic strategies, we examined 254 patients who had received non-cuffed hemodialysis catheters at our hospital between April 2006 and March 2009. We assessed 14 patients who developed CRBSI; the incidence of CRBSI was 4.6 episodes per 1,000 catheter days. Of these CRBSI patients, 79% (11/14) had internal jugular vein catheters, and the average duration of catheterization before the occurrence of CRBSI was 11.8±8.1 days. Gram-positive cocci were discovered in 79% (11/14) of CRBSI cases, and Staphylococcus aureus was the most common species. The pathogenic bacteria were drug-resistant, with 57% (8/14) sensitive to anti-MRSA agents only. Mortality after 30 days was 14% (1/7) for patients treated with and 57% (4/7) for those not treated with anti-MRSA agents (p=0.078). The rate of pyretolysis within 72 h was 86% (6/7) for patients treated with and 14% (1/7) for those not treated with anti-MRSA agents (p=0.0291). There were two cases of septic shock, one case of suppurative thrombophlebitis, and one case of liver abscess as metastatic infectious complications for patients not treated with anti-MRSA agents. This surveillance study demonstrated that drug-resistant Gram-positive cocci, including MRSA, are common in CRBSI, and we therefore conclude that it is important to diagnose CRBSI early and start empirical therapy that includes anti-MRSA agents.

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Purpose: To investigate the status of uremic pruritus in hemodialysis patients and the efficacy of nalfurafine hydrochloride (nalfurafine), an opioid κ-receptor agonist, for the treatment of resistant pruritus. Methods: Hemodialysis patients recruited from 17 institutes in the Tokai area replied to the questionnaire under their own volition. They answered regarding the intensity of pruritus using the Shiratori severity score and visual analog scale (VAS), and described the frequency of pruritus and disturbance of sleep due to it. Results: The pruritus survey involved 1,936 hemodialysis patients (1,261 men and 675 women). The mean age and duration of hemodialysis were 65.1 years and 6 years and 11 months, respectively. Of the 1,927 patients who replied to the questionnaire, 1,289 (66.9%) had pruritus. The intensity of pruritus increased with an increase in its frequency (p<0.01). Sleep disturbance by pruritus was observed in 41.2% (461/1,120) of patients, and the grade of disturbance worsened with an aggravation of the intensity of pruritus (p<0.01). Nalfurafine reduced the intensity of pruritus in 63.5% (33/52) of patients. The intensity of pruritus determined by VAS (mean±SD) reduced from 70.9±22.2mm before to 39.5±29.8mm after administration (p<0.01). In addition, nalfurafine lowered the grade of sleep disturbance in 42.3% (22/52) of patients and reduced the number of patients with sleep disturbance by pruritus from 23 to 10. In particular, the number of patients with moderate or severe sleep disturbance decreased from 15 to 2 after the initiation of nalfurafine treatment. Conclusion: Uremic pruritus continues to occur in many hemodialysis patients and lowers their quality of sleep. Nalfurafine may be effective to improve pruritus.

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The skin perfusion pressure (SPP) in the plantae declines in dialysis patients with peripheral artery disease, but also varies according to a patient's blood pressure at the time of measurement. A decline in SPP is also seen among those in good health. In this study, SPP was measured between the base of the first and second toes on both the left and right feet of 105 healthy persons and 78 dialysis patients, and factors that influenced the measured SPP were evaluated. These factors were broadly categorized into: 1) measurement factors that varied with every measurement, 2) arteriosclerotic factors that varied with each patient. The measurement factors used were the upper arm systolic blood pressure and pulse, and the arteriosclerotic factors used were the arteriosclerotic risk factor (model 1) and arteriosclerotic test max-IMT in the common carotid artery (model 2). Independence between the elements which comprise each factor was assumed. Any relation between the two explanatory SPP variables showed linear variation when there was a difference on a continuous scale in the average of the healthy and dialysis groups, or average value variation when there was a difference on a nominal scale. Therefore, the same models were found in healthy persons and dialysis patients. Model 1 was analyzed using multiple regression analysis containing a qualitative scale, and model 2 was analyzed using multiple regression analysis. Looking at changes in each model caused by the arteriosclerosis factors, as arteriosclerosis progressed, the number of healthy persons increased and dialysis patients decreased. These results suggest that SPP increased in the early stages of arteriosclerosis and decreased in the later stages.

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The impact of hepatitis C virus on patient survival after kidney transplantation is controversial. Hepatitis C virus infection is an important consideration in kidney transplantation for graft recipients. The aim of the present study was to assess the impact of HCV infection on patient and graft survival in a large cohort of living-donor kidney transplanted patients. We reviewed 964 patients including 50 with positive anti-HCV and 914 without serological markers of HCV who received living-donor kidney transplantation in the Department of Urology at Tokyo Women's Medical University Hospital from January 1990 to December 2009. The 10-year patient survival rate was significantly higher in the anti-HCV-negative than in the anti-HCV-positive group. The 10-year graft survival rate was significantly higher in the anti-HCV-negative group than in the anti-HCV-positive group. Post-transplant glomerulopathies, chronic rejection, and post-transplant diabetes mellitus have the potential to adversely affect graft survival. The results of this study indicate that kidney transplant recipients who are positive for HCV antibodies have lower rates of graft survival and lower survival rates after transplantation than anti-HCV-negative recipients.

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