Of 75 patients introduced to hemodialysis treatment at our institutes, correlation between incidence of symptoms such as bone or joint pain, and bone parameters was analyzed.
The incidence of these symptoms was 63%. The pain during movement of joints was 51%: knee joint pain 31%; shoulder joint pain 27%; hand-finger pain 15% and so on. The spontaneous skeletal pain was 21%-15% in upper extremities; 8% in lower extremities; 3% in lumbar and back area. The incidence increased throughout the duration of hemodialysis. Eighty two percent was recognized in females 40 to 50 years old.
These patients were separated into two groups according to the symptoms; symptom group (group A) and no symptom group (group B). The serum β₂-microgroburin level increased significantly in group A compared to group B. Levels of C-PTH, INS-PTH and osteocalcin were higher in group A than group B.
The incidence of symptoms was 50% in the normal grade of the microdensitometry method in metacarpal bone and 60% in the third grade. The MCI scores were positively correlated with the duration of hemodialysis in both groups and the ∑GS/D scores were also so correlated in group A. The ∑GS/D scores were significantly higher in the group with pain during movement of joints (group C) than the group with spontaneous pain (group D). The MCI scores and levels of serum Pi, C-PTH and INS-PTH were higher in group C than group D.
Based upon these observations, it is concluded that renal osteodystrophy due to moderate stage of hyperparathyroidism exists in groups A and C. It should be further analyzed whether spontaneous skeletal pain is related to osteomalacia due to aluminium intoxication.

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The patients with CAPD peritonitis were treated by intravenous or intraperitoneal administration of vancomycin (VCM), which was isolated from Streptomyces orientalis and was known to be extremely effective for Gram positive bacteria. Seven patients (five males and two females) were submitted for this study. Concentrations of VCM in both serum and peritoneal fluid were measured by fluorescent polarization immunoassay (FPIA) for seven days following an intravenous administration of VCM (30mg/kg). Serum concentrations of VCM revealed sufficient therapeutic level for seven days after a single dose of VCM. Peritoneal clearance of VCM showed a tendency to decrease concomitatly with the improvement of peritonitis. In five patients, VCM was given intraperitoneally for 10 days with an initial dose of 200mg per 1, 500-2, 000ml CAPD fluid bag and then 100mg per bag. The bag was changed 6 times daily for the first two days and then 4 times daily until the 10th day. Balance studies of the drainage of CAPD fluid suggested that approxmately 70% of the VCM given intraperitoneally was absorbed and the serum concentration reached as high as therapeutic range within twenty-four hours after initiation of intraperitoneal VCM treatment. In all patients, symptoms of peritonitis disappeared within three days and cell counts in the dialysates became less than 100/mm³ within five days. Mild palpitation, Muscle pain and itching appeared in 3 of 5 patients during the intravenous administration of VCM. On the other hand, no obvious side effects occurred during the intraparitoneal treatment.
These results indicate that intravenous and intraparitoneal administration of VCM are safe and highlg effective in the treatment of CAPD peritonitis attributed to Gram positive organisms.

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Marked hyperaldosteronemia with hypereninemia has appeared in about 20% of the patients with long-term hemodialysis therapy in Japan. Many of them have been reported to be hypotensive.
To evaluate these patients, we studied retrospectively 19 non-nephrectomized recipients of renal transplantation from related living donors.
PRA and PAC had been measured in 11 patients. Seven patients had great hyperaldosteronemia (PAC>160ng/dl) with hypereninemia (PRA>5ng/ml/hr). Six of them had experienced hypotensive episode during hemodialysis. In the 7 patients, weight gain was 11.1±1.4% on the 15th day after transplantation, indicating that their post-dialysis weight was significantly lower than ideal body weight obtained when kidney function was normal. The PRA and PAC normalized within 1 week after transplantation. However, in the other patients, the weight gain was 0.2±1.1%.
In conclusion, chronic dehydration during hemodialysis therapy can cause much hyperaldosteronemia that can be corrected by fluid replacement. Measurement of PRA and PAC may be useful to evaluate the dry weight of chronic hemodialysis patients.

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