The clinical studies of hemofiltration were done on the points of clinical application and its effectiveness. Sieving coefficient was approximately 1.0 for low molecular substances such as urea and creatinine to inulin with molecular weight of 5, 000 daltons. The extraction rate for urea, creatinine, uric acid and phosphate was more than 40%, respectively, when 20l of body fluid was exchanged. Serum electrolytes and blood gas were also normalized to the desirable levels.
Fourteen patients with chronic renal failure were on hemofiltration, and 8 of them had been on hemofiltration more than 18 months. Hemofiltration was done in postdilution mode, 3 times weekly. Two of Filtryzer B-1 (polymethylmethacrylate, 1.35m², hollow fiber artificial kidney, Toray) in series were employed for hemofilter. Equalizing systems between filtrate and substitution fluid were volume-controlled NY-II (Nipro) and weight-controlled M-5, 000 (Toray). Composition of substitution fluids was Na 135-140mEq/l., K 2.0mEq/l, Cl 104.75-107.3mEq/l, Ca 3.5-3.8mEq/l., Mg 1.5mEq/l, respectively, and acetate 40mEq/l or lactate 37.5-38mEq/
The patients with symptoms of dialysis disequilibrium syndrome during hemodialysis were tolerable to hemofiltration without symptom. Anephric patients required less blood transfusion in hemofiltration than in hemodialysis. A patient suffered from pain in the eye because of glaucoma recieved painless treatment on hemofiltration. Not only depletion syndrome but also other side effects called in question did not appear in 14 patients.
Solute kinetics using ²²Na were studied in hemofiltration in comparison with hemodialysis. Two groups of patients were selected to make study, hemofiltration and hemodialysis group. It took more than 12 hours for equilibrium after oral administration of ²²Na. The concentrations of Na and ²²Na in serum were measured every an hour during procedures, and total removal amount of ²²Na was compared between two groups.
Hemofiltration could remove significantly larger amount of ²²Na than hemodialysis although body weight loss was comparable between two groups. On the other hand the disappearance curve of serum ²²Na concentrations was significantly delayed in hemofiltration more than in hemodialysis. But Na concentration in serum was not changed significantly during procedure in both groups. It is also noted that a decrease of plasma osmolarity was steeper during hemodialysis than hemofiltration. These results indicate that ²²Na in hemofiltration can move between fluid spaces more promptly and smoothly than in hemodialysis, suggesting more efficient removal of intracellular fluid.

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Two patients with chronic renal failure were treated with hemofiltration. Toray B-1 (two in series) was used as a filter, and DFX-1 (Nikkiso) as a substitution device.
During five-hour procedure about 20l filtrate was removed, a large part of which was replaced with HF-A solution (Fuso: Na 140, K 2, Ca 3.5, Mg 1.5, Cl 107, Acetate 40mEq/l) by the “post dilution” mode.
The result of the treatment was summarized as follows.
1. The extraction ratios of urea, creatinine, uric acid per treatment were somewhat lower than those of the conventional six-hour hemodialysis.
2. Pre and post treatment level of serum electrolytes was almost same with that of hemodialysis. However, phosphate was removed more efficiently, so that serum phosphate level decreased and aluminum hydroxide therapy could be abandoned.
3. Hypotension, developed in the course of the previous hemodialysis therapy, was improved by the hemofiltration therapy, possibly due to a high sodium concentration (140mEq/l) of the replacement solution. It is suggested that the same result will be obtained by the hemodialysis with a dialysate of high sodium concentration. However, CTR increased in our patient without body weight gain, so that the clinical course must be carefully observed.
4. Acidosis was adequately improved by the use of HF-A solution containing 40mEq/l acetate. Significant increase in blood acetate concentration was not observed during the treatment.
5. The frequency of the disequilibrium syndrome was remarkably reduced during the hemofiltration therapy.
6. Marked improvement of uremic pruritus, skin pigmentation was observed.
7. It is important to control the temperature of the replacement fluid in order to prevent the chillness during the hemofiltration procedure.
8. In our study, amino acid loss in the filtrate was about five grams per treatment, which is thought to be fully tolerable. However, in the long term hemofiltration therapy, the depletion syndrome of protein, amino acids, hormones, vitamins must be carefully watched, especially in the pediatric patients.
9. With the introduction of hemofiltration to a brain tumor patient, we try to increase the dose of local anti-tumor agents and to reduce the side effect by removing them from blood by the hemofiltration. The results will be reported elsewhere.

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Cardiovascular function of patients with acute and chronic renal failure was determined by means of Swan-Ganz thermodilution catheter. These studies were carried out in the patients under hemodialysis and an comparison was made with the results of cardiac patients. These patients were divided to:
Group 1: Twenty patients with coronary-sclerosis without angina attack (control group)
Group 2: Nine patients with chronic renal failure under longterm hemodialysis
Group 3: Four patients with acute renal failure undertaking hemodialysis
Group 4: Nine patients with symptoms of heart failure due to congestive cardiomyopathy.
As a result, left ventricular function curve, indicating the relationship of left ventricular stroke work index and diastolic pressure of pulmonary artery (PAD) was obtained. Because of the fall in cardiac index (C. I.) and the rise in PAD, Group 4 showed a down-and-rightwards shift of the left ventricular function curve, which implied diminished cardiac pumping function. However, the results in Group 2 and 3 were not different from that of the control (Group 1).
These results indicate that most of patients with acute and chronic renal failure have left ventricular function within normal range. Since PAD and mean right atrial pressure which related to preload and C. I. increased slightly in patients with renal failure, it may be considered that most of symptoms like left-sided heart failure, which are usually seen in patients with renal failure, are pulmonary congestion due to fluid overload.

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1α-OH-D₃ (1α-D₃) was given to 30 patients who had been dialysed chronically using the dialysate with a calcium concentration of 3.75mEq/l and whose serum calcium level was less than 8.5mg/dl. They were given 1α-D₃ with the dose of 0.75μg/day in the morning for 18 weeks. During 18 weeks study period the following results were observed.
We defined the agent was effective if a patient's serum calcium concentration showed a greater increase than 0.5mg/dl at some time during 18 weeks study period. Under this definition the effectiveness rate was 66.7%. Eleven patients out of the 30 patients (36.7%) showed the abnormally high PTH value, however there were no difference in the effectiveness rate of 1α-D₃ between the patients with abnormal PTH value and the patients with normal PTH value.
The following changes of the concentration of vitamine D₃ metabolites were observed during the study period.
1) 25-OH-D₃
The average control value before the beginning of the administration was 34.2±12.0ng/ml, which was within normal limits (10-55), and the value decreased significantly to 21.8±12.5 (p<0.05) in the 6th week of the study period. The value in the 12th week and in the 18th week was same as the value in the 6th week.
2) 1, 25 (OH)₂-D₃
The average control value before the study period was 28.9±11.7pg/ml, which was the lower limit of the normal range (27-43) and the value increased significantly to 40.5±10.0 in the 6th week. However in the 12th week the value decreased to 27.8±6.3, which was almost same as the prestudy control value in and the valve the 18th week was same as that of the 12th week.
3) 24, 25-(OH)₃-D₃
The average control value showed a pretty high value of 22.9±51.1ng/ml (normal range 1.8-3.8). The value decreased to 6.2±5.7 in the 6th week of the study period. However this value was not significantly different from the control value. The value was 2.3±2.8 in the 12th week and 1.1±1.0 in the 18th week of the study period respectively.

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