In order to clarify the pathogenesis of glucose intolerance in chronic renal failure, we investigated it from the viewpoint of insulin receptor. IV-GTT (0.5g/kg) was performed in 10 undialyzed and 12 dialyzed patients with chronic renal failure and 6 normal subjects, and their insulin receptors were examined. ∑IRI (the sum of IRI during IV-GTT) in the undialyzed group was 445±78μU/ml, which was significantly higher than that (260±38μU/ml) in the normal group. The K value (glucose disappearance rate) in the undialyzed group was 1.32±0.30, which was significantly lower than that (1.92±0.25) in the normal group and that (1.82±0.34) in the dialyzed group. No significant difference in K value was recognized between the normal and dialyzed groups.
The specific binding of ¹²⁵I-insulin to erythrocytes (2.4×10⁹ cells/ml) in the undialyzed group was 3.99±0.76% which was significantly lower than that (5.50±0.69%) in the normal group. However, no significant difference was observed between the normal and dialyzed groups. When competition data for the three groups were subjected to Scatchard analysis, the difference in binding to erythrocytes appeared to be due to the difference in receptor concentration rather than receptor affinity (receptor concentration: 42, 58, and 64 sites/erythrocyte in the undialyzed, dialyzed, and normal groups, respectively). In the dialyzed group, the correlation coefficients between the specific binding of ¹²⁵I-insulin and K value (r=0.542) were higher than those between the binding and fasting IRI, ∑IRI (r=-0.381, -0.272).
From these results, it is suggested that glucose intolerance in chronic renal failure is founded on a decrease in insulin receptor concentration, and that hemodialysis improves this glucose intolerance through increased sensitivity to insulin action in the peripheral tissue with accompanying normalization of the insulin receptors.

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Comparative studies on cardiac function were performed in 6 patients with chronic renal failure during hemodialysis (HD) and hemofiltration (HF). The cases were divided into 2 groups on the basis of the duration of HD (maintenance 3, introduction 3), and were also divided into 3 groups according to the primary disease (diabetic nephropathy 3, chronic glomerulonephritis 2, and chronic pyelonephritis 1). HD was performed with a hollow fiber dialyzer using AK-Solita as the dialysate, HF was performed with a Sartorius Hemofilter using HF-Solita as the substitution fluid.
Methods: A Swan-Ganz thermodilution catheter was inserted into the pulmonary artery and the changes in cardiac function were evaluated before, at 1 and 3 hours after starting, and at 30 minutes after ending HD and HF, respectively.
Results: 1) When the cardiac function curve was drawn with the pulmonary capillary wedge pressure (PCWP) and the left ventricular stroke work index % (SWI%) expressed as percent of the value before starting HD or HF, the changes or reductions in cardiac function were smaller during HF than during HD. 2) When the relationthip between the body weight decreasing rate (ΔBW%) and SWI% during HD and HF was investigated, SWI% tended to produce a smaller reduction during HF than during HD regardless of the value of ΔBW%, and all of the relationships between log (SWI%) and ΔBW% except in patient (case 4) revealed a high inverse correlation coefficient (HD: r=-0.83, P<0.01, HF: r=-0.75, P<0.01) for the straight line.
Conclusion: The changes or reductions in cardiac function were less during HF than during HD when judged on the basis of contractility.

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The aluminum kinetics and serum aluminum correlation with other serum components were examined in 80 patients undergoing chronic hemodialysis. The mean serum aluminum level was 8.12±5.32μg/dl before dialysis, and all patients were above the normal level of loss by 0.7μg/dl. After 5 hours of dialysis, the mean serum concentration was 6.66±4.26μg/dl aluminum, showing a tendency the towards decrease during dialysis. In 20 of the 80 patients, the serum aluminum was examined in blood taken from both the blood inflow site and outflow site after 30 min of dialysis. There was a significant difference between the serum aluminum at the inflow site, 8.10±4.96μg/dl, and that at the outflow site, 5.56±2.82μg/dl. We measured the aluminum in the ultrafiltrate, showing an ultrafiltrability of about 28% of the total serum aluminum. This suggests that 72% of the serum aluminum is protein bound. We used purified city water to prepare a dialysate that contained constantly 0.3-0.7μg/dl aluminum. The amount of free serum aluminum averaged about 1.3μg/dl in our patients, so there was net aluminum change across the dialyzer membrane. For individual patients with free serum aluminum concentra tions higher than the dialysate concentration, aluminum was removed during dialysis. Aluminum was transferred from the blood of individuals with high ultrafiltrability to the dialysate. We also found that the concentration of free diffusible aluminum in the serum in terms of the total serum aluminum level decreased during dialysis. The serum aluminum level was not correlated to the daily dose of aluminum compounds, but was significantly correlated to the duration of treatment. Various serum components that are diagnostic markers of renal osteodystrophy such as parathyroid hormone, calcitonin, calcium and phosphate were not correlated to the serum aluminum levels. We found that the aluminum dialysance depends on the concentration gradient between the ultrafiltrable free serum aluminum and dialysate aluminum concentration. To remove aluminum from the blood during hemodialysis, it is necessary to prepare a dialysate whose aluminum concentration is below the individual's measured ultrafiltrable serum aluminum level.

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Subtotal parathyroidectomy (PTX) was performed in 17 patients with severe renal osteodystrophy (ROD) associated with secondary hyperparathyroidism, and the effects of PTX on extraskeletal uremic manifestations were evaluated.
Preoperative levels of PTH were elevated in all patients (mean level of PTH 18.2ng/ml) and postoperative levels returned to normal in almost patients. The weight of the removed parathyroid glands ranged from 0.45g to 6.55g (mean weight 2.7g). The mean preoperative RBC count was 268×10⁴ and after PTX it increased to 292×10⁴; Hb and Ht were similarly increased, but reticulocytes were unchanged. Systolic and diastolic BP were dropped immediately after PTX and thereafter continued at a reduced level. The mean fall in systolic BP was 17mmHg and of diastolic BP, was 7mmHg. Preoperative MCV of peroneal nerve was in the normal range, and after PTX it was unchanged. Dry weight was increased in most patients after PTX.
Currently, PTH is considered a major uremic toxin and the source genesis of many of the uremic manifestations, namely anemia, hypertension, neuropathy and protein wasting.
From our results, it is considered that PTH is probably a major component of many uremic toxins.

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Anti-HBs antibody production was investigated in 8 hemodialysis patients after injection with inactivated HBs vaccine, and the immunological parameters were also studied. The results obtained were as follows. 1) The capacity to produce anti-HBs antibody was decreased in hemodialysis patients and the occurrence of the antibody was late. 2) Immunological studies revealed an increase in the ratio of OKT8 positive cells in the nonresponders to HBs vaccine of the patients. 3) The in vitro proliferative responses of the lymphocytes to various mitoens were not different between the responder and nonresponder groups. 4) The levels of serum immunoglobulins, complements, parathyroid hormone, and ferritin were not different between the responder and nonresponder groups.
From there results, it is suggested that the decreased anti-HBs antibody production in hemodialysis patients may be due to suppressed immune responses mediated by suppressor T cells.

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Blood access instituted in our hospital was evaluated for the long-term patency and the hemodynamic effects.
1) Follow-up studies. (a) Subcutaneous A-V fistulae on the forearm have been made in 227 cases up to now. Institution of new blood access was required in 16 of them. Patency was 92% one year after surgery and was still as high as 80% after 6-10 years; A-V fistulae which have been used without trouble for one year can be expected to be patent for a much longer duration. (b) E-PTFE grafts were implanted in 28 patients. They consisted of 17 A-V grafts (loop or straight grafts connecting the artery and vein of forearms or thighs) and 11 jumping grafts (subcutaneous bypass of the femoral artery with anastomosis at the inguinal region and the lower thigh). Although 5 grafts were obstructed or could not be used, 18 were patent for one year and 6 months on the average with the longest patency for 6 years and 7 months. The result is inferior to the patency of subcutaneous A-V fistulae, but grafts might be regarded as satisfactory for blood access of secondary choice.
2) The hemodynamic effects of blood access were studied by the measurements of blood flow with an ultrasonic flowmeter and cardiac output by the dye-dilution technique. (a) In the case of subcutaneous A-V fistulae, blood flow velocity of the brachial artery averaged 5 times greater on the fistula side than on the other side. Shunt flow was regarded as excellent when the flow velocity of the brachial artery on the fistula side exceeded 20cm/sec and was at least twice that on the other side. The fistulae which fell short of the criteria required repair. (b) The flow rate of femoral A-V loop grafts of ID 8mm exceeded 1 liter/min in all of 3 patients. Of those 3, 2 elderly patients developed heart failure, possibly because of the high shunt flow rate. Heart failure did not occur in patients with other A-V grafts of ID 5-6mm implanted on the forearms and thighs. As jumping grafts do not increase cardiac output, A-V fistula and graft in the 2 patients with heart failure were changed to jumping grafts, which improved the condition considerably. Jumping grafts might be considered as blood access of choice, particularly for patients with heart failure or ischemic heart disease.

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Functional nursing records are strongly required in the care of long-term dialysis patients. Four types of record form were designed and printed for continuous nursing.
Form I, All information from the patients on starting dialysis is itemized and summarized on this form. The form is very useful for communicating the collected information and for comprehending the points of problem as a matter of nursing.
Form II, Many kinds of clinical data are entered on this form in series, such as body dimensions, vital signs, blood pressure, medications, dietary treatment and principal labolatory findings. According to the detailed records concerning the clinical course, assessments of the critical events, early findings and treatments are readily possible.
Form III, The clinical course and laboratory findings are summarized on this form every month, and every year.
Form IV, If the patient moves to another dialysis center and where this form is delivered, remarks from the viewpoint of nursing are itemized in detail.
It should be emphasized that, in this way, much of the information from the patient came to be smoothly communicated.

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This paper discusses the solute removal dynamics in CAPD. Newly defined characterization parameters, namely, time-averaged clearance CL and concentration (CS) in stable periods, are introduced into the comparison of removal dynamics in several hemopurification modalities. These parameters are calculated from the solute concentration and the conventional clearance by compartment model.
As a result, only in CAPD the calculated values of (CS) for low molecular metabolites are higher than clinically obtained values. The solute generation rate (G) of these substances in six CAPD patients decreased by 20-30% of the value obtained when the patients were treated with HD.
The molecular weight (MW) -CL profile in CAPD is similar to that in HF, but the MW-CS profile in CAPD is similar to that in HDF because of the reduced G in low molecular metabolites.

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In order to determine the toxicity of plastics in madical use, the effect of their extracts on cells were examind.
The addition of water and saline extracts to cell cultures had no effect on the growth of L-929 cells. However, the growth was inhibited by adding ethanol and serum extracts of ethylene-vinylacetate copolymer, non-plasticized and plasticized polyvinyl chloride to the culture. The degree of inhibition depended on the dose of the extracts. Morphological changes in the cells were also observed when these extracts were added to the culture.
Water and saline have been principally used as the eluants of plastics for safety evaluation. The results indicate the necessity of safety evaluation using fat-soluble extracts as well, in regard to medical devices which must contact the blood.

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Purpose: The present investigation was carried out to evaluate the usefulness of measuring platelet size distributions (PSD) as a parameter of the biocompatibility of dialyzer membranes.
Materials and Methods: As an in vitro study, platelet rich plasma (PRP) from 9 normal volunteers was brought into contact with Cuprophane and ethylene and vinyl alcohol (EVAL) and thereafter the PSD was determined. As a control, 3μM ADP was used in place of membranes. As an in vivo study. PRP from 9 uremic patients on maintenance dialysis with an original disease of chronic glomerulonephritis was used. Three dialyses with Cuprophane, EVAL, and polymethylmethacrylate (PMMA) were performed for each patient. Blood was obtained 5 min after the initiation of dialysis from the inlet (Bi) and outlet (Bo) of the dialyzer. In the meantime, the dialysate was not supplied to prevent the influence of calcium ions. The PSD of the plasma so obtained was measured.
Results: In healthy controls, a decrease of PSD was obtained in the range of 5.66-11.32μ³ and an increase in the range greater than 16.98μ³ after the addition of 3μM ADP. Contact of the PRP with Cuprophane brought about the same increase and decrease, while EVAL showed only the increase of PSD greater 16.95μ³. In the clinical dialysis, a similar decrease and increase in the Bo compared with the Bi were obtained with Cuprophane, while no particular changes were noted with EVAL and PMMA.
Conclusion: Contact of PRP with Cuprophane brought about a decrease of PSD in the small size area and an increase in the greater size area, suggesting activation of platelets by the membrane leading to aggregation. The platelets appeared to behave differently in EVAL and PMMA. It is concluded that PSD measurements are useful for evaluating the biocompatibility of dialyzer membranes.

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