Pregabalin (Lyrica^TM) is a neuropathic pain relief drug eliminated primarily via renal excretion with an urinary excretion rate of 90%. Safe clinical practice is to adjust its dose according to patient renal function. In this study, we investigated the occurrence of adverse events in 120 patients at Kouseikai Hospital who were prescribed pregabalin below the manufacturer's recommended dose between June 2010 and November 2013. The results indicated that 14 patients experienced adverse events affecting the central nervous system, such as dizziness and lethargy. Many of the adverse events appeared within 6 days after the start of drug administration. The weight of patients who experienced adverse events was significantly lower than that of those who did not (p=0.005). Patients with impaired renal function had a significantly higher incidence of adverse events (4% in 73 non-impaired renal function patients vs. 23% in 47 impaired renal function patients; p=0.003). Because of this association between impaired renal function and the incidence of adverse events of pregabalin, it is important for pharmacists not only to understand the renal function of individual patients accurately and to optimize their pregabalin dose accordingly prior to administration, but also to develop an individualized drug administration plan that takes patient weight into account.

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【Background】Liposomal amphotericin B (LAMB) can be used without the need for dose reduction even in patients with renal dysfunction owing to its liposomal property. However, many questions exist in terms of the pharmacokinetics during renal replacement therapy. Previous studies on the administration of liposomal amphotericin B during renal replacement therapy and measurement of the blood kinetics only involved continuous renal replacement therapy, plasma pheresis, or low-flux hemodialysis. In the present study, we report the serum concentrations in patients receiving hemodialysis using a high-flux membrane.【Method】A 72-year-old male patient receiving maintenance hemodialysis was diagnosed with invasive systemic aspergillosis and administered LAMB at 300 mg (4.6 mg/kg/day) once daily every day. Hemodialysis was performed for 5 hours per session, 3 days per week, using a blood pump (at 200 mL/min) and APS18MD (high-flux membrane, polysulfone; Asahi Kasei Kuraray Medical, Tokyo, Japan). LAMB was administered through extracorporeal circulation for 5 hours on the dialysis days and intravenously for 5 hours on the non-dialysis days. For administration during hemodialysis, the blood LAMB concentration were measured every hour on the inlet and outlet sides of the dialyzer and the dialysate LAMB concentration was measured once. For intravenous administration on the non-dialysis days, the LAMB concentration in peripheral blood was measured.【Results】For administration during hemodialysis, no significant difference in the serum concentrations was noted between the inlet and outlet sides of the dialyzer, with the dialysate concentration at the lower detection limit. For both administration during hemodialysis and intravenous administration, no significant difference was observed in the serum concentrations.【Conclusions】These results suggest that LAMB can be administered with and without hemodialysis, and no dose adjustment is required even when using polysulfone/high-flux membrane.

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We investigated high-density area (HDA) in the stomach on abdominal CT in hemodialysis patients with lanthanum therapy. We examined abdominal CT results of 173 examinations in 70 patients during the therapy; 67 of these 173 examinations (39%) in 42 patients (60%) showed HDA in the stomach. The duration of lanthanum therapy in patients with an HDA was significantly longer than that in patients without it (p<0.01). Furthermore, the duration of lanthanum therapy was positively correlated with the grade of HDA (p<0.0001). We performed gastric endoscopy in 4 cases. It showed white thickening of the gastric mucosa along the fold. Pathological findings of biopsy showed the tissue deposition of lanthanum with macrophages. The presence of lanthanum in the gastric mucosa was confirmed by inductively coupled plasma mass spectrometry (ICP-MS). Eight months after discontinuation of lanthanum therapy, two cases were examined by CT and one of them also underwent gastric endoscopy. The HDA or white thickening of the gastric mucosa persisted in the findings for these procedures. Our findings suggest that further investigations of the influence of lanthanum carbonate on gastric mucosa are needed.

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【Purpose】 The aim of this study was to investigate the social activities and health-related quality of life (KDQOL-SF^TM) of community-dwelling diabetic nephropathy patients undergoing dialysis.【Subjects and methods】The subjects comprised 75 diabetic nephropathy patients (aged≥40 years) who were undergoing dialysis at one of the three medical institutions in A prefecture. The data were obtained from their medical records and an interview survey using a questionnaire. Social activities were composed of three subscales ([personal activities],[interaction with close friends]and[participation in group activities]).The relationship between health-related quality of life for the implementation status and willingness of the subject to undertake social activities was examined.【Results】There were associations of quality of life with[personal activities],[interaction with close friends]and[participation in group activities]. Patients who engaged in social activities at least once per week on non-dialysis days had higher health-related QOL than those who did not.【Conclusions】Health-related QOL was higher in patients who engaged in social activities on non-dialysis days, indicating the importance of encouraging patients to being willing to participate in and continue with social activities even when their daily lifestyle is restricted by regular outpatient treatment.

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Recently, a growing number of patients with cancer have received hemodialysis because of an improvement of their mortality due to advances in anticancer therapy. On the other hand, it has been reported that some patients with cancer have coagulation disorders. A 72-year-old male who received chemotherapy for intrahepatic bile duct cancer developed appetite loss and general malaise. He showed acute on chronic renal failure and bradycardia due to hyperkalemia. A flexible double-lumen (FDL) catheter was inserted into the right jugular vein and hemodialysis was initiated. At 8 days in hospital, computed tomography showed a high-density area in the right posterior brain. Magnetic resonance venography revealed right transverse sinus thrombosis. The FDL catheter was removed and intravenous heparin infusion was started immediately. Although right jugular vein puncture is recommended for cannulation of an FDL catheter, we need to keep in mind cerebral vascular thrombosis as a complication of right jugular vein catheterization, especially in cases with malignant disease.

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Perirenal hematoma is an uncommon disease caused by trauma, neoplastic disease, renal cyst infection, or other factors. It is sometimes caused by anticoagulant or antiplatelet agents and occasionally occurs in patients on dialysis therapy. When considering the etiology of perirenal hematoma in dialysis patients, acquired cystic disease of the kidney (ACDK) may be an important factor, as all eight patients whom we treated had ACDK. Five of these eight patients had no past history of calculi, neoplastic lesions, or trauma, and perirenal hematoma in these five was associated with rupture of ACDK. Six of the patients with hematoma were peritoneal dialysis patients, and their drained dialysis solutions were all hemorrhagic, suggesting that perirenal hematoma should be considered in the differential diagnosis when bloody drainage is seen in peritoneal dialysis patients. The incidence of ACDK-associated perirenal hematoma is likely to increase with the growing number of long-term dialysis patients. If dialysis patients suddenly complain of lower back pain or if bloody drainage is seen in peritoneal dialysis patients, perirenal hematoma should be considered, and the patient should be subjected to close monitoring. Therapeutic regimens should be established with appropriate consideration of the progression of anemia, the patient's systemic condition, and potential complications of renal cell carcinoma.

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A 57-year-old male, who had undergone maintenance hemodialysis (HD) for 35 years, suffered from a long period of HCV infection. He was treated with branched-chain amino acids, levocarnitine and lactulose syrup, and the concentration of bicarbonate in the dialysate was changed from 30 mEq/L to 25 mEq/L to prevent alkalemia. However, he developed repeated hepatic encephalopathy after HD. His liver was cirrhotic and multiple portal-systemic shunts were demonstrated by three-dimensional CT. When measured by color Doppler ultrasonography, the blood flow in the portal vein was decreased after HD. This decrease occurred because of direct flow into the systemic circulation through portal-systemic shunts due to a decrease in the intravenous pressure after HD. After the blood purification modality had been altered to hemodiafiltration (HDF) , the decrease in the portal blood flow was improved. The recurrent hepatic encephalopathy disappeared after the addition of aminoglycoside antibiotics and after the modality of blood purification therapy had been modified. On the basis of this experience, we discuss comprehensive measures to prevent hepatic encephalopathy in hemodialysis patients.

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