【Objective】This study aimed to prove the effects of FT3 on GA in diabetic and non-diabetic patients on maintenance hemodialysis. 【Patients and Methods】We examined the associations between GA (or FT3) values and several clinical variables in 49 diabetic and 49 non-diabetic patients on maintenance hemodialysis. 【Results】In the 49 diabetic patients, the average plasma glucose (PG) showed a significant positive correlation and only FT3 showed a significant negative correlation with GA. By stepwise multivariate regression analysis, PG was positively associated and only FT3 was negatively associated with GA. In the 49 non-diabetic patients, age and PG showed significant positive correlations, and body mass index (BMI), albumin, P, FT3, and Cr showed significant negative correlations with GA. By stepwise multivariate regression analysis, age was positively associated, and BMI and P were negatively associated with GA. In diabetic patients, BMI showed a significant positive correlation, and GA and TSH showed significant negative correlations with FT3. By stepwise multivariate regression analysis, BMI was positively associated and only GA was negatively associated with FT3. In non-diabetic patients, BMI, Alb, and Cr showed significant positive correlations, and age and GA showed significant negative correlations with FT3. By stepwise multivariate regression analysis, Cr was negatively associated and BMI was positively associated with FT3. 【Conclusion】GA values are more influenced by FT3 independently of glycemia in diabetic patients than in non-diabetic ones.

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【Purpose】Approximate curves for the pattern of change in circulating blood volume during hemodialysis were reviewed. 【Target and Method】Circulating blood volume changes of 95 stable chronic hemodialysis patients were measured during hemodialysis, under the following conditions : bed rest, in a supine position, constant blood flow, and constant ultrafiltration rate. The following equations were considered as approximate curves : 1) linear curve y=Cx+D, 2) hyperbolic curve+linear curve xy=Ax²+Bx+C, 3) parabolic curve+linear curve y=A√x+Cx+D, 4) logarithmic curve+linear curve y=ALn(x)+Cx+D, and 5) exponential curve+linear curve y=AExp(Bx)+Cx+D. 【Result】The coefficients of determination of 540 points for each equation (for three hours), excluding the measurement start point, were as follows : 1) 0.913±0.0725, 2) 0.992±0.0083, 3) 0.957±0.0401, 4) 0.955±0.0383, and 5) 0.962±0.0367. The relationship of the magnitudes of the coefficients of determination was as follows : 1) < 4) < 3) < 5) < 2). In addition, coefficient A of equation 2) correlated with the ultrafiltration rate. 【Conclusion】This study discovered that the rather simple formula of equation 2), which fitted the data better, can be applied to estimate blood volume change and be useful for the prevention of hypotension during hemodialysis.

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【Objective】Some reports have claimed that Kt/BSA, which is Kt standardized with body surface area (BSA), is a better marker for hemodialysis (HD) dose than Kt/V. According to a study by Spalding, which used Watson’s V as total body water, Kt/V overestimated HD dose in female or smaller male patients compared with that in larger male patients, if Kt/BSA was regarded as the reference marker of HD dose, because V/BSA was less in female and smaller male patients than in larger male ones. In this study, we investigated whether the same result would be obtained in Japanese HD patients when total body water (V) actually measured by bioimpedance spectroscopy (BIS) was used. 【Method】V was actually measured in 132 maintenance HD patients after treatment. Excess fluid was calculated and V was corrected with the excess fluid (cV). 【Results】When cV was used as V, V/BSA, which is a conversion factor from Kt/V to Kt/BSA, was significantly lower in female patients than in male ones. When V/BSA was compared among four groups classified by gender and physique according to cV, V/BSA was significantly lower in female or smaller patients. 【Conclusion】Kt/V was indicated to overestimate HD dose in smaller or female Japanese HD patients compared with that in larger male ones, from a study in which V was actually measured by BIS.

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A postal questionnaire enquiring about the acceptance of peritoneal dialysis (PD) patients was carried out at 1,139 geriatric health services facilities in the Kanto area. The questions were about the knowledge and current status of the acceptance of PD patients, the reason for the lack of acceptance of PD patients, and the requirements for acceptance. Among 535 facilities at which our questionnaires were completed, PD patients live in only 4 facilities. The main reasons for not accepting them were the absence of a linked hospital for emergencies, requests from patients, and the difficulty of dialysate exchange. However, 34% of the facilities that do not accept PD patients may accept them by improving these factors.

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We present an unusual pulmonary complication associated with a dialysis catheter. A 49-year-old female was admitted to our hospital with pain in the lower limbs. Hemodialysis was initiated at the age of 32 following acute kidney injury of unknown etiology. She had vascular graft infections at the ages of 44 and 47. A permanent cuffed dialysis catheter was inserted via the right internal jugular vein, and she developed Staphylococcus aureus bacteremia and left sacroiliac arthritis one year after the catheter insertion. At the age of 49, she was hospitalized for a detailed examination because of pain in the lower limbs. Chest computed tomography showed multiple nodular lesions with interior cavitation and feeding vessel signs ; therefore, we diagnosed septic pulmonary embolism (SPE). Magnetic resonance imaging revealed right sacral osteomyelitis and abscessation. The source of this may have been catheter-related bloodstream infection. Blood cultures taken on admission were negative because ceftriaxone had already been administered. The administration of tazobactam/piperacillin hydrate and vancomycin resolved the symptoms, and shadows in the lung field and right sacral osteomyelitis decreased. We should recognize SPE as a complication of bacteremia and sepsis in hemodialysis patients.

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A 65-year-old man developed rapid deterioration in renal function, demonstrating an elevated serum creatinine level of up to 9.2 mg/dL, after previously being treated for lung involvement due to granulomatosis with polyangiitis (GPA) with positive findings of myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA) for two months. Renal pathology revealed necrotizing crescentic glomerulonephritis with giant cells, and immunofluorescence microscopy showed characteristic linear deposition of IgG along the glomerular basement membrane (GBM). According to the positive findings of anti-GBM antibodies of over 350 U/dL, the patient was diagnosed with rapidly progressive glomerulonephritis (RPGN) mediated by anti-GBM antibodies. At the onset of the development of the lung lesions, the patient was negative for proteinase 3-antineutrophil cytoplasmic antibodies (PR3-ANCA), and had slightly elevated titers of MPO-ANCA. However, only the latter increased significantly at the onset of development of the rapid deterioration in renal function. The patient’s renal function was not restored when treated with a combination of plasmapheresis and a high dose of intravenous methylprednisolone, and the patient ultimately required maintenance dialysis. We report this as a case of GPA followed by anti-GBM disease. This case highlights the importance of making a pathological diagnosis of small vessel vasculitis and considering its pathogenesis.

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We report a hemodialysis (HD) patient with renal cell carcinomas and pulmonary cysts who was diagnosed with Birt-Hogg-Dubé (BHD) syndrome. A 73-year-old female with a history of 26 years on HD was admitted to our hospital due to unidentified fever. The patient had bilateral renal cell carcinomas, lung metastases, and pulmonary cysts. Family history revealed that her mother and aunt had had episodes of pneumothorax. These findings suggested BHD syndrome as the underling disorder. Genetic testing of folliculin (FLCN) was performed and its heterozygous mutation was detected. Hereditary diseases including BHD syndrome should be considered when HD patients with renal cell carcinomas have multiple pulmonary cysts and/or a family history of pneumothorax.

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IgG4-related disease (IgG4 RD) has recently been established as a new clinical entity characterized by plasma cell infiltration resulting in sclerosis in various organs, but the pathophysiology and clinical features are not fully understood. Here, we report a rare case of IgG4 RD that developed during chronic hemodialysis. A 61-year-old male with polycystic kidney disease who had been on hemodialysis for seven years was referred to our hospital because of nausea, cough, and asthma that had recently appeared during a hemodialysis session. The symptoms continued even after dialyzers were changed to other types. He had been experiencing submaxillary gland swelling for five years. His blood tests showed eosinophilia (8,000/μL), hypergammaglobulinemia (serum IgG 5,462 mg/dL), and a rise in IgG4 concentration (1,540 mg/dL). A biopsy of the gland revealed infiltration of plasma cells, including more than 50% IgG4-positive cells, without evidence of tumor ; thus, he was diagnosed with IgG4 RD. No involvement was found in other organs, including pancreas. Oral prednisolone (30 mg/day) was initiated and the symptoms during hemodialysis immediately disappeared, with gradual improvement of eosinophilia and submaxillary gland swelling. We should consider the possibility of IgG4 RD when we see patients with episodic asthma during chronic hemodialysis.

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