We know little about how patients undergoing CAPD treatment can take a bath without the risk of peritoneal infection. To examine the possible risk of infection caused by bathing, a bacteriological study was carried out in five patients with chronic renal failure on CAPD treatment. The clinical diagnosis of the patients were chronic glomerulonephritis in four and diabetic nephropathy one, the latter of whom diabetic triopathy.
There were four bacteriologically positive swabs among 20 samples when the patients bathed without covering the exit of the catheter. In the patients who covered the exit, there was one positive swab in 10 samples. Only normal floras of the skin, such as staphylococcus epidermidis and diphtheroids, were identified. There was no significant difference between these two groups by the Mann-Whitney U test. In the culture of the samples of peritoneal dialysate, there were no positive findings.
These results suggest that patients on CAPD treatment can bathe safely even when they do not cover the exit of the catheter. Our findings might suggest the safety of bathing without covers and provide useful gudelines to patients under CAPD treatment.

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We studied the effects of the application Artemisiae capillaris Flos, which is one of the oldest known Chinese medical plants, as an anti-inflammatory, antipyretic, choleretic and diuretic agent, on long-standing severe pruritus in patients on hemodialysis.
In order to determine the response of short-term use, we selected six individuals suffering from severe pruritus among 131 patients on hemodialysis and examined the period of effectiveness, i.e., from the application of the drug to the onset of itching. The experimental group treated with Artermisiae capillaris Flos showed a prolonged period of effectiveness as opposed to the control group treated with antihistamine ointment (P<0.05). Furthermore, the mixture of Artemisiae capillaris Flos and antihistamine ointment was more effective than the other treatments (P<0.05).
Long-term therapy with Artemisiae capillaris Flos was undertaken in patients with various severe skin lesions during the period between Feburary and June 1984. Those treated with Artemisiae capillaris Flos showed marked improvement of pruritus, hyperkeratosis and xeroderma (P<0.01). In contrast, papules and pigmentation remained unchanged. This treatment had no side effects during the experimental period. This therapy is effective not only for pruritus, but also for hyperkeratosis and xeroderma in patients on hemodialysis. In addition, it is simple, convenient, inexpensive, safe and devoid of complication or hazards.

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The influence of different buffer substances on metabolic acidosis in patients treated with various modes of hemopurification including, hemodialysis with acetate dialysate (Ac-D) and with bicarbonate dilalysate (Bc-D), and hemofiltration with acetate, lactate and bicarbonate replacement fluids (HF-A, HF-L, and HF-B) was studied. Twenty-six uremic patients were observed to compare the effects of Ac-B and Bc-D on the lipid metabolism. The results indicated:
1) In the both types of dialysis, no significant differences were observed between the pre-and post-dialysis levels of blood pH, HCO₃^-, and base excess. But the correction of metabolic acidosis showed a tendency to be mild in Bc-D as compared with Ac-D.
2) With HF-A and HF-L, the correction of blood pH was not satisfactory. On the other hand, with HF-B, those was a tendency to alkalosis.
3) With Ac-D and HF-A, the blood acetate levels showed gradual increment toward the end of the treatment. Furthermore, the post-treatment levels were high in Ac-D as compared with HF-A.
4) With HF-L, post-filtration levels of blood lactate and pyruvate were significantly increased.
5) Ac-D was changed to Bc-D in all 26 patients, while HDL-cholesterol levels rose and triglyceride levels fell significantly after Bc-D treatment for one year in six (23.1%).

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Not only the number of hemodialysis patients, but also the number of hemodialysis centers (HDCs) has been increasing geometrically in Japan. In spite of the increasing numbers of HDCs, new patients still have difficulties in finding an HDC suitable for their rehabilitation. However, the geographical distribution of HDCs in Japan has not yet been established. The aims of this study are as follows: 1. determining the geographical distribution of HDCs, 2. assessing whether the geographical distribution of HDC is proper or not and 3. determining the relationship between several factors and the geographical distribution of HDCs.
The regions divided by postal code numbers (RDP) were adopted for calculating the geographical distribution rates (GDR) of HDC. GDR was defined as (the number of RDP in which an HDC exists)/(total number of RDP). The following 10 items were calculated: 1) GDR of all HDC (all-HDC) in 1983, 2) GDR of HDC for evening or night (HDC-evening-night) in 1983, 3) GDR of HDC designated for the institution assisting in patients' medical expenses (HDC-designated) in 1983, 4) GDR of HDC in general hospitals in 1983, 5) the increasing rate (IR) of GDR of all-HDC during 1973-1978, 6) IR of GDR of HDC-evening-night during 1973-1978, 7) IR of GDR of HDC-designated during 1973-1978, 8) IR of GDR of all-HDC during 1978-1983, 9) IR of GDR of HDC-evening-night during 1978-1983 and 10) IR of GDR of HDC-designated during 1978-1983.
The analysis was accomplished by means of multiple regression models. Variables for the model were selected from socio-economic factors, medico-mortality factors and living-environmental factors.
GDR was 1) 0.674, 2) 0.495, 3) 0.610 and 4) 0.394, The IR of GDR was 5) 50.1%, 6) 192.3%, 7) 70.7%, 8) 15.4%, 9) 44.7% and 10) 29.5%. Each IR of GDR was correlated with socio-economic factors (p<0.01-0.005). GDR was most closely correlated with either medico-mortality factors (1), 2), 4)) or living -environmental factors (3)) (p<0.005) rather than socio-economic factors. GDR (1), 3)) and IR (8), 10)) were correlated negatively with either urbanization or medicalization and GDR (2), 4)) and IR (9)) were positively.
Although the GDR had been increasing, the present GDR was far from the ideal value of 1.000. For better rehabilitation of hemodialysis patients, both a sufficient GDR of HDC-evening-night and the institution assisting the management of small rural HDCs are required. Furthermore popularization of home hemodialysis, CAPD and renal transplantation is strongly desired.

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Clinical studies were conducted on urinary tract infection in 9 maintenance hemodialysis patients who had diabetic nephropathy as the reason for their dialysis.
It was found from the urinalysis findings that 8 of the 9 patients (88.8%) showed pyuria, having subjective symptoms of one sort or another. Generally, diabetic patients suffer the complication of vesical dysfunction due to a high incidence of peripheral neuropathy and they frequently suffer from urinary tract infection due to residual urine. Our studies also revealed that 6 of the 7 patients (85.7%) had vesical dysfunction. It is therefore necessary to pay due attention to the vesical function of the patient if diagnosis of diabetes has been established. Also, instructions should be given to the patient to perform intermittent self-catheterization using aseptic precautions to prevent urinary tract infection.
Inflammation at the acute phase can be effectively treated by the general administration of antibiotics even in those patients without residual renal function. Chronic symptoms such as lower abdominal discomfort will be eliminated by bladder instillation of antibiotics by which eliminate the bacteria.
Early diagnosis and treatment are mandatory and due attention must be paid to the vesical function for treatment of urinary tract infection of maintenance hemodialysis patients who have diabetic nephropathy as the reason for dialysis.

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A study was performed on 27 patients undergoing CAPD at Jikei University Hospital. Standard acid-base studies, plasma lactate and pyruvate levels were measured during CAPD. The results indicated that plasma lactate, pyruvate levels and the L/P ratio increased significantly in accordance with age and the duration of dialysis. However, those levels remained within normal range and yielded adequate correction of metabolic acidosis. In diabetic renal failure, buffer is metabolized adequately without an unphysiological increase of lactate and pyruvate levels.
CAPD is advantageous for the constant correction of metabolic acidosis as compared with hemodialysis and intermittent peritoneal dialysis. However, it is not clearly understood whether the amount of sodium lactate (35mEq/l) contained in conventional dialysate is adequate for Japanese patients or whether the buffer is metabolized properly in elderly patients, patients with diabetic renal failure and those on long-term dialysis. Thus, this study was aimed to evaluate the adequacy of dialysate sodium lactate levels in the situations mentioned above.

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A newly designed monitoring system intended for the improvement of conventional dialysis together with a reliable control system, with which running dialysis may be kept under close scrutiny, was successfully tested.
The control system incorporates automatic and manual changeover devices as well as an emergency source of electric power, whereas the monitoring system involves a graphic monitor assisted by a personal computer, a locally installed control and alarm panel, and a remote-control and alarm monitor to provide accessibility to operating data through daily and monthly printouts.
Within the design concept of the control system, flowing features were taken into consideration: options for sophisticated and automated operation: easy maintenance: flexible operability: close linkage with dialysis therapy: higher reliability and the possibility of expansion and reconstruction in the future.
Being automated for the most part, the system offers a higher availability rate, well-equipped condition diagnosis and a better accessibility to particulars of the apparatus during its operation. Thus, the control and monitoring systems were found helpful in obtaining a more reliable dialysis system.

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Peritonitis is still one of the major adverse complications of continuous ambulatory peritoneal dialysis (CAPD). We evaluated antibacterial defense mechanisms in dialysate.
Opsonic molecules and opsonic activity in dialysate were measured. The effects of IgG in dialysate on phagocytosis of S. aureus and S. epidermidis by neutrophils in vitro were also studied. The results are summarized as follows:
1) Opsonic molecules and opsonic activity were detected in dialysate, and both of them were increased with peritonitis.
2) Bacterial phagocytosis by neutrophils in dialysate was potentiated by increasing IgG in dialysate.
These results suggest that IgG in dialysate plays an important role in the antibacterial treatment of peritonitis. The instillation of IgG in dialysate might be beneficial in the treatment of peritonitis.

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To study the effects of dietary treatment on the prognosis of patients with chronic renal failure (CRF), an attempt has been made to differentiate between two groups of patients, one of which continued on the diet (group 1), the other of which eventually underwent dialysis treatment (group 2), over the past four years. The diet consisted of high-quality proteins (20g or 30g per day) and high-energy sources (2, 000kcal per day) and was used depending on the patient's renal function. Thirty-two patients comprised group 1 and 50 belonged to group 2. Fourteen dropped out. The average period of dietary treatment was 23.8±16.1 (mean±SD) months for group 1 and 14.1±10.9 months for group 2. Clinical data obtained at the initiation and end of the follow-up were as follows. Serum urea nitrogen was 50.1±21.4mg/dl vs 41.2±21.4mg/dl (p<0.02) in group 1 and 82.3±31.0mg/dl vs 94.4±27.4mg/dl (p<0.02) in group 2. Serum creatinine was 4.0±1.6mg/dl vs 5.0±2.7mg/dl (nonsignificant) in group 1 and 7.4±2.9mg/dl vs 12.7±4.5mg/dl (p<0.001) in group 2. Serum total protein levels remained unchanged in both groups. Hematocrit value was not significantly changed in group 1, but decreased in group 2.
The above results strongly suggest that prognosis of chronic renal failure patients has been markedly improved by dietary treatment not only by delaying the introduction of dialysis therapy, but also by preventing the progression of impaired renal function.

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