St. Mary's Hospital Kidney Center established in 1971 now treats 87 in- and out-patients with chronic renal failure at its dialysis department during day and night hours under Hospital dialysis I. C. U. (Intensive Care Unit) and L. C. U. (Limited Care Unit) systems. After the fatients had received guidance on diet and water control other than dialysis in daily life at the dialysis department, the treatment team started to make homecare visits in 1976 in an attempt to establish closer communications with the patients and their families.
As a result, the patients' volition toward self-control and social rehabilitation was much improved with the cooperation and understanding of their families. The subjects involved are the patients now receiving dialysis treatment, and the number of calls made since the start of home-care visiting reached 108 cases in December 1979. The members of the treatment team made it a rule to hold a meeting before making home-care visits, each visiting group consisting of 3 persons, i.e. head nurse, nurse-in-charge and dietician, the necessary guidance being issued at the patients' homes regarding their daily life and dietary schedules.
Results
(1) Singificant improvement of anemia was recognized.
Mean Ht. and mean Hb. levels as low as 20.3% and 6.9%, respectively, before home visiting, showed an increase of about 6% (up to 26%) in the former and about 1.69d/dl (up to 8.5g/dl) in the latter, 6 months after visiting.
(2) Both emotional stability and life adaptability were found favorable in psychological tests carried out after visiting, while attitude of the patients proved to be more positive.
(3) The rate of social rehabilitation has now registered a level of 70% at this hospital. Although the treatment team has repeatedly visited the subjects' work places and schools, the vocational rehabilitation has yet to be imporved in view of a lack of understanding and interest on the part of the community. Thus, we medical staffs are required to make furhter efforts to improve the situation. It is our intention to continue to visit patients' homes to enlarge the sphere of clinical nursing in order to achieve successful follow-up care other than bedside treatment.

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Methyl alcohol poisoning was frequent after the Second World War but has become rare. After hemodialysis (H. D.) was introduced in Japan, only one case of methyl alcohol poisoning treated with H. D. was reported (Kan et al. 1979). Gonda et al. reviewed the worldwide literature in English and reported 35 cases of methyl alcohol intoxication treated with H. D. 1961-1978. Our case seems to be the second case of methyl alcohol intoxication treated with H. D. in Japan.
The patient, a 34-year-old sailor, ingested approximately 250cc. of methyl alcohol diluted with water after consuming six bottles of beer. He developed headache and visual disturbance and became comatose. On arrival at the hospital, he was in shock and developed respiratory arrest, which was treated successfully. The arterial blood pH was 6.7, HCO₃ was 6mEq/l and anion gap 40.
The patient received H. D. for five hours, using 1.1M² of hollow fiber. We administered 1800cc. of 7% NaCO₃ intravenously, combined with ethanol ingestion through a stomach tube intermittently. The blood methyl alcohol level was 258mg/dl on arrival and dropped to 48mg/dl after five hours of H. D. The patient's temperature rose to 42°C. and he developed congestive heart failure. He expired the following day.
In this case, there was a long interval from ingestion of methyl alcohol to treatment, and metabolic acidosis was remarkably severe. These two factors seem to explain why we failed to save the patient.

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The correlation between iron metabolism and HLA antigens have been investigated in 50 patients on hemodialysis. HLA type was determined by microcytotoxicity technique and serum ferritin levels were measured at megular intervals. All of these patients had been taking 50 to 210mg of oral iron daily for up to 5 years, but none were given parenteral iron or blood transfusion. Patients with hepatic dysfunction or infection were excluded from the study. Three of four patients with HLA BW-60 and two of five with HLA B-7 had high serum ferritin levels (>600ng/ml) which fluctuated when oral iron intake was stopped or restarted. Although HLA A-3 and B-14 are knows to be associated with hemochromatosis, no patients with these antigens were seen in this study. None of these patients have yet experienced symptoms or sighs of hemochromatosis. These results suggest that dialysis patients with HLA B-7 or BW-60 antigens should be carefully followed for evidence of iron overload when treated with oral iron.

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Plasma levels of ACTH and cortisol were measured by radioimmunoassay in dialysed patients with chronic renal failure. Plasma ACTH levels were almost within the normal range and cortisol levels were slightly higher than the normal levels. Statistically significant difference in plasma ACTH and cortisol level was not found among the hypotensive, normotensive and hypertensive group in dialysed patients with chronic renal failure and there was no statistically significant correlation between the levels of plasma ACTH and cortisol. The mean levels of plasma cortisol before hemodialysis were higher than the levels after that and there was a significant difference between the ratio of plasma cortisol level before and after hemodialysis (Fa/Fb) and weight loss following hemodialysis and between Fa/Fb and of mean blood pressure. Diurnal rhythm of plasma ACTH and cortisol levels in dialysed patients with chronic renal failure were similar to the levels in healthy subjects. Rapid ACTH test showed normal response in the patients.
These findings may indicate that pituitary adrenocortical function was almost normal and that there would be no possibility that the pituitary adrenocortical system plays a role as a hypotensive factor in dialysed patients with chronic renal failure.

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THE PURPOSE OF THE STUDY:
The study was carried out to find out if the difference in bicarbonate infusion systems produces different effects on ionized calcium concentrations.
METHODS
Four types of bicarbonate infusion system were evaluated: 1) central batch system, 2) a single patient supplyer with pulse mixing pump, 3) a single patient supplier with pulse infusate system, and 4) a single patient supplier with roller infusate system. In all of these systems, acid was added to stabilize the dialysate. Three types of dialysates were studied (for the evaluation of stability): 1) control: acetate added, 2) bicabonate added at the concentration of 4.4%, 3) bicarbonate added at the concentration of 7.0%.
SUMMARY
Although aslight difference in the concentration in ionized calcium was observed, each of the four systems in the present study was satisfactory from the clinical viewpoint. The measurement of ionized calcium concentration in the dialysate is a convenient way to evaluate the effect of bicarbonate dialysate supplier.

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Recent advancement in management of hemodialysis patients has increased the number of aged patients, however, major risks have encountered among them because of the diminishing reserved function of their organs by aging. Trouble in blood access is one of the major complications in these patients.
From 1976 through 1981, 12 patients, older than 75 years, with chronic renal failure were enroled to the chronic hemodialysis program at the renal center of Keio University Hospital.
In five out of the 12 patients, 14 shunt failures developed due to thrombosis, infection and aneurysm on 11, 2 and one occasions, respectively. Nine of 14 shunt failures took place in short after construction, namely within 10 times of use, including 5 before use.
The shunt failed group tended to have laboratory findings beyond normal range, either higher or lower, including platelet count, serum cholesterol and serum fibrinogen as well as mean blood pressure, although there was no significant differences in these average values comparing with those of the shunt patent group.
There were 2 patients in whom polytetrafluoroethylene (PTFE) grafts were used for blood access because of frequent shunt failures of the autogenous grafts.
Use of anticoagulants such as heparin, urokinase, warfarin and aspirin, single or combination thereof seemed effective to lessen the loss of blood access by thrombosis, especially in these two patients.
Our proposal is to use anticoagulants and/or antiplatelet agents routinely in aged patients maintained with chronic hemodialysis.

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