[Purpose] The purpose of this study was to examine the cut-off value in blood removal failure of each indicator based on ultrasonography of the arteriovenous fistula. [Subjects and methods] It was targeted at 374 patients (1,096 inspections) with arteriovenous fistula who underwent ultrasonography from January 2008 to December 2010. Subjects were classified into excellent blood removal and blood removal failure groups. The Receiver Operating Characteristic curve of the blood flow volume, resistance index, and stenosis diameter was produced, and the cutoff value was calculated using the Youden index. Moreover, the area under the curve was produced and compared regarding the ability to make a diagnosis with each indicator. [Results] In the Receiver Operating Characteristic analysis of the blood flow volume, resistance index, and stenosis diameter, cutoff values were 350mL/min, 0.70, and 1.3mm, respectively. Moreover, the area under the curve in the blood flow volume, resistance index, and stenosis diameter were 0.982, 0.904, and 0.924, respectively.［Conclusions］It was suggested that the blood flow volume, resistance index, and stenosis diameter which are obtained by ultrasonography were indicators which can be used to predict blood removal failure. It was suggested that the blood flow volume had a particularly high diagnostic capability compared with the other indicators, and was an excellent indicator.

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Purpose: To help novice doctors perform ultrasound-guided central venous access insertion, we introduced a novel simulation program. Participants and methods: Between April 2008 and April 2012, 10 novice doctors performed ultrasound-guided central venous access insertion in our nephrology department. The training program was as follows: 1) Lecture on the theory of ultrasound-guided puncture, 2) Repeated watching of an instructional DVD showing an instructor's performance with a patient, 3) Training using a self-made simulator and catheter kit, 4) On-the-job training with the instructor after watching the instructor's performance with patients: the instructor held an ultrasound probe together with the trainee, and directed the trainee on how to proceed for introducing the needle. The ultrasound image was recorded with a digital video recorder. 5) The trainee reflected with the instructor while watching the video after the on-the-job training. The recorded ultrasound video was given to the trainee as a CD-R. 6) The contents of the reflection were summarized as a portfolio by both the trainee and instructor, which was reviewed later from time to time. 7) The trainee performed the procedure by him or herself. 8) The impressions of the simulation program were obtained by interview. Results: After introducing the program, about 25 double lumen catheter insertions/year and 50 femoral central venous punctures with a long hemodialysis needle/year were all successfully performed under ultrasound guidance without serious complications. All trainees felt that the simulation program had been useful. The instructor's stress was lower than that before introducing the program. Conclusion: Introducing the simulation program was effective to increase the safety in learning the central venous catheter procedure by novice doctors.

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Objectives: Hemodialysis patients are exposed to various oxidative stress conditions, and 8-hydroxy-2'-deoxyguanosine (8-OHdG) is a marker of oxidative DNA stress. Here, we measured plasma 8-OHdG in patients undergoing maintenance hemodialysis, and then investigated its relationships with the geriatric nutritional risk index (GNRI), nutritional status via albumin, etc., inflammatory markers such as CRP and interleukin-6 (IL-6), as well as the arteriosclerosis-related factor fetuin-A, contributions to renal anemia, and erythropoiesis-stimulating agent (ESA) quantities used. Subjects：138 patients were undergoing stable maintenance hemodialysis. Of these, 95 were men, and 43 women, with a mean age of 69±11 (38 to 88 years) and a mean dialysis history of 58±60 months (3 to 390 months). Methods: 8-OHdG was measured with a high sensitivity enzyme-linked immunosorbent assay (ELISA). Moreover, IL-6 and fetuin-A were also measured with ELISA. GNRI was calculated with the formula proposed by Bouillanne et al., and modified by Yamada et al. Correlations between blood biochemistry tests for hemoglobin (Hb), hematocrit (Hct), albumin, calcium (Ca), inorganic phosphorus (P), parathyroid hormone (intact-PTH), CRP, urea clearance (Kt/V), PCR, the ESA quantity used, and dialysis duration were comparatively investigated. Results: In investigations of 8-OHdG in men and women, significantly higher values were noted in women (p<0.05), with 0.26±0.08ng/mL for men and 0.29±0.09ng/mL for women. Moreover, a significant positive correlation of the patients' 8-OHdG with age was noted (p<0.005). Furthermore, a significant negative correlation was observed with the nutritional evaluation index and serum albumin (p<0.0001), and a significant negative correlation with GNRI was also noted (p<0.0001). Meanwhile, a significant positive correlation was observed with the inflammatory marker CRP (p<0.0001), and a significant positive correlation with IL-6 was also noted (p<0.0001). However a significant correlation with the arteriosclerosis-related marker, fetuin-A, was not observed. While no correlative relationship with BUN was noted, a significant negative correlation with creatinine was observed (p<0.05). When investigating relationships between 8-OHdG and ESA quantities used, as well as ESA to Hb ratios, a trend toward more ESA being used as 8-OHdG rose was noted, although significant correlations were not identified. However, a positive correlation with the erythropoietin resistance index (ERI) was observed. Conclusions: Plasma 8-OHdG, a marker of oxidative DNA stress, reflects the nutritional status and chronic inflammation in dialysis patients, and can be an index of erythropoietin resistance.

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Objective: The purpose of this study was to develop a Fluid Management Self-Efficacy Scale for Hemodialysis Patients. Internal consistency, structural validity, and criterion-related validity were tested. Methods: Items were developed to assess self-efficacy in a number of situations associated with difficulty in fluid management. Items were generated from an analysis of interview data in people receiving hemodialysis, and those were analyzed based on the theory of Self-Efficacy of Bandura. A panel of professionals with knowledge of the self-efficacy theory reviewed the first draft of the scale. After face validity, the study was conducted. Data from 220 hemodialysis patients were collected, and 209 subjects were analyzed. Results: A one-factor structure was revealed from the results of exploratory factor analysis. The scale items numbered 15, and the cumulative contribution rate was 55.7%. Structural and criterion-related validities were supported. The Fluid Management Self-Efficacy Scale for Hemodialysis Patients was significantly correlated with the interdialytic weight gain. The high alpha coefficient (0.95) supported the scale as internally reliable. Conclusion: The Fluid Management Self-Efficacy Scale for Hemodialysis Patients was revealed to have satisfactory psychometric properties. The scale may be used in research or in clinical settings to study the mediating effects of self-efficacy or to modify hemodialysis patients' fluid management behavior. Although this first validity study is promising, further validation focusing on reliability and validity is needed.

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A 78-year-old man was referred to our clinic for an incidental left renal mass six years after the induction of chronic hemodialysis. CT showed a cystic mass with a solid component enhanced gradually by contrast medium, and suggested to be a renal cell carcinoma. He underwent laparoscopic nephrectomy. The histological diagnosis was cavernous hemangioma.

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A 33-year-old female complained of exopthalmos, palpitation, and dyspnea. A 28-year-old male complained of edema, high fever, and general malaise. Hyperthyroidism was suspected from their clinical data. Their blood pressure fell and they were in a shock state due to thyrotoxic storm. The blood pressure rose on tracheal intubation, intraaortic balloon pumping, and percutaneous cardio-pulmonary support. Thyrotoxic storm was not improved by pharmacological treatment, but was improved by the combination of continuous hemodiafiltration and slow plasma exchange. The half-life of thyroid hormones and thyroid-stimulating hormone were markedly shortened. The combination of continuous hemodiafiltration and slow plasma exchange is effective for the treatment of thyrotoxic storm.

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