Immune responsiveness in 79 patients with chronic renal failure (CRF) was studied using monoclonal antibodies to each of the lymphocyte subpopulations and a T cell-independent B cell mitogen, Staphylococcus aureus Cowan I (STA). Among them, eight hemodialysis (HD) patients were given HBs vaccine and were followed for the anti-HBs antibody responsiveness. The results obtained were as follows. 1) Anti-HBs antibody responses in HD patients were suppressed, and low levels and late appearance of the antibodies were observed as compared to those in healthy controls. 2) Immunological studies revealed reduced OKT4/OKT8 ratios in low responders to HBs vaccination as compared to those in responders. 3) As the duration of HD increased, so did the percentages of OKT8⁺ cells, while those of OKB1⁺ cells declined. 4) The proliferative responses of peripheral blood lymphocytes (PBL) stimulated with STA were decreased in the patients with CRF, except for those on HD for one to five years, and the in vitro syntheses of immunoglobulins (lg) from the PBL were also decreased.
From these results, it was considered that the suppression of anti-HBs antibody responses to HBs vaccination in HD patients may be related in part to the increased ratio of OKT8⁺ cells, and such an increase of OKT8⁺ cells is intensified with the prolongation of HD.

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In the field of hemodialysis therapy, we medical social workers play an important role in helping patients with a final view to their rehabilitation to a normal social life. With this in mind, we have been giving our an orientation. We would like to report on six patients who were rehabilitated to their lives in society.
Ninety-five patients on hemodialysis therapy in our clinic were divided into three groups, young (20-39 years old, 35%), middle-aged (40-59 years old, 42%), and elderly (more then 60 years old, 23%), and were given orientations on how to live in society according to their respective ages.
As for the orientation of the young group, helping patients to return to work in society was of importance. In the case of a 39-year-old man who worked as a taxi driver and of a 32-year-old woman who found a job in printing after a two-year search for work, we were successful in obtaining effective results by performing hemodialysis therapy when they were off-duty.
In the case of the middle-aged patients, considerable orientation concerning household affairs was conducted. One 49-year-old woman managed to return to doing housework after CAPD induction and is able to do more than she used to.
As for the elderly subjects, we attached importance to readjustment to everyday life, how to live in the family, and how to deal with the other socjal servjce systems that would care for them. A 77-year-old man who lives in a large family who cares for him and a 75-year-old man who lives alone under public assistance are reported.
In the first stage of hemodialysis treatment, the patients are strongly apt to think of themselves as disabled, and such thinking for a prolonged period deprives them of the will to readjust to life in society. To avoid such a development, we need to orient our patients to life in society as soon as possible and to do our case work with the cooperation of the rest of the medical staff.

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In order to evaluate the optimal concentration of dialysate bicarbonate, we studied the blood-gas data and correlation between dialysate bicarbonate and post-dialysis plasma bicarbonate in a total of 118 dialyses in 31 stable chronic hemodialysis patients. The dialysate was Kindary AF-1, which contained about 8mEq/l of acetate. We changed dialysate bicarbonate levels from 20.5mEq/l to 35.2mEq/l for every dialysis. Hemodialysis was done for four hours, with a blood flow of 150ml/min and a dialysate flow of 500ml/min, using a hollow fiber dialyzer with a surface area of 0.8m² to 1.2m².
It was desirable to increase plasma bicarbonate to about 24mEq/l at the end of dialysis.
One hundred ten dialysis sessions were divided into three groups depending on predialysis plasma bicarbonate levels: the mild acidosis group (20≤HCO₃^-<24mEq/l, n=31), the moderate acidosis group (16≤HCO₃^-<20mEq/l, n=60), and the severe acidosis group (HCO₃^-<16mEq/l, n=19). In all three groups, there was a high positive correlation between dialysate bicarbonate and post-dialysis plasma bicarbonate. The optimal concentration of dialysate bicarbonate was suggested as to be 23.8mEq/l for the mild acidosis group, 27.9mEq/l for the moderate acidosis group and 30.0mEq/l for the severe acidosis group.
In conclusion, the optimal concentration of dialysate bicarbonate was variable depending on the predialysis plasma bicarbonate level. In the mild acidosis group, bicarbonate dialysis may cause alkalosis after dialysis. It is desirable to use two or more bicarbonate dialysates properly with different concentrations.

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In order to investigate the peculiarities of acid-base balance in hemodialysis patients, a new statistical method, an autoregressive approach to spectral analysis, was adopted. It was found that the multivariate feedback system is involved in the regulation of acid-base balance in hemodialysis patients. Major factors for inducing metabolic acidosis in these patients included the protein and the amino acid metabolisms. Although electrolyte metabolism is also involved in the regulation of acid-base balance in these patients, its role seemed to be secondary to those of other intracellular metabolisms. Analysis with impulse response function strongly suggested that metabolic acidosis can become a trigger of anemia and hypertension in these patients.

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We evaluated the technique of high-sodium bicarbonate dialysis using a Rhodial 75, a closed-circuit batch system (75l tank volume) manufactured for acetate dialysis. Kindary AF-1 was used as dialysate concentration. Bicarbonate dialysate could be produced in the tank without precipitation of carbonates by infusing, first, A solution, second, about 60l of treated water and, third, B solution.
In order to change high-sodium dialysate to normal-sodium dialysate, we devised a method to dilute the dialysate of the Rhodial 75 during dialysis. The dilution method was to absorb treated water from the inlet of the tank, simultanously draining dialysate in an equal amount from the outlet of the tank. It took only five or six minutes, and the electrolyte concentration of the diluted dialysate was stable.
We performed 230 high-sodium bicarbonate dialyses in two chronic dialysis patients. The sodium concentration of the dialysate was adjusted to a maximum of 160mEq/l in the first two hours of dialysis; then the dialysate was diluted by the above method. Therefore, the sodium concentration of dialysate was adjusted to a normal level of 140mEq/l in the last three hours. The patients felt well and their serum electrolytes were stable during dialysis.
In conclusion, high-sodium bicarbonate dialysis could be performed using the Rhodial 7 in a safe and simple manner.

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