Sympathetic nervous system function was evaluated in 26 normal subjects and 23 dialysis patients by means of plasma levels of catecholamines and the response to phentolamine (α-blocker) injection and norepinephrine infusion.
In the supine position, plasma catecholamines in dialysis patients ranged widely between levels lower and higher than seen in normal subjects. There was no significant correlation between plasma norepinephrine and mean blood pressure (MBP) in the supine position.
Phentolamine injections produced more marked drops in MBP in dialysis patients than it did in normal subjects, but it also produced an increase in MBP in one case.
There was no significant correlation between baseline plasma catecholamines and decreases in MBP, but the changes in plasma norepinephrine tended to correlate with the changes in MBP.
NE infusion caused a significant increase in MBP and decrease in heart rate in both groups.
Responsiveness to exogenous norepinephrine was normal in two patients with hypertension but lower in three patients with normotension.
These data indicate that abnormalities in the function of the sympathetic nervous system are seen in hemodiaiysis patients and suggest that the sympathetic nervous system may participate in the regulation of blood pressure in these patients.

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A mechanism for the rise in plasma β₂-microglobulin (β₂-MG) following hemodialysis (HD) was studied in vivo and in vitro. It can not be explained by enhanced synthesis of β₂-MG or by enhanced release from circulating blood cells according to our calculations based on data from in vitro experiments. Post-HD plasma levels of β₂-MG, myoglobin, and α₁-microglobulin were compared to predialysis levels, which were significantly increased by 7-17% even if corrected for hemoconcentration. To study the intercompartmental shift of low molecular weight proteins (LMWPs) during HD, an in vitro experiment was performed using CAPD drainage fluid, with or without 5% albumin, simulating intravascular and interstitial fluids passing through cuprophane membrane dialyzers. LMWPs shifted from the interstitial space to the intravascular space concomitant with the movement of water. The concentration of LMWPs increased in inverse proportion to the reduction of extracellular fluid volume (ECFV). In conclusion, increased plasma levels of β₂-MG following HD are mainly due to the reduction of ECFV by fluid removal.

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Changes in the endocrinological environment and testicular volume of male chronic hemodialysis patients were studied. Peripheral blood serum levels of LH, FSH, PRL, testosterone, estradiol, ACTH, cortisol and zinc were measured. Testicular volume was maesured by means of an orchidometer as well as by ultrasonography in order to obtain the most objective evaluation possible. There were 15 chronic hemodialysis patients and 23 controls whose serum levels of BUN and Cr were within the normal range.
We also evaluated relationships among factors such as duration of hemodialysis, endocrinological environment and testicular volume measured by ultrasonography in chronic hemodialysis patients.
Serum levels of LH and FSH were significantly higher and levels of testosterone were significantly lower in chronic hemodialysis patients than in controls.
Testicular volume measured using an orchidometer was significantly less in chronic hemodialysis patients than in the controls.
Althogh, positive correlations were observed between duration of hemodialysis and serum levels of LH and FSH, an inverse correlation was found between duration of hemodialysis and serum levels of testosterone. A positive correlation, however, was detected between duration of hemodialysis and testicular volume as measured by ultrasonography. Testicular dysfunction was observed clearly in chronic hemodialysis patients, however, testicular volume was increased in relation to the duration of hemodialysis.
From these results, it appears that testicular volume increased due to interstitial tissue edema and proliferation of connective tissue.

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Indwelling urokinase immobilized femoral vein catheters were positioned in 9 chronic hemodialysis patients. Serum concentrations of plasminogen, fibrinogen, fibrinopeptide A, fibrinopeptide Bβ15-42, fibronectin and von Willebrand factor (vWF: Ag and RCoF) were measured before and after the first 3 hemodialyses. None of the concentrations of plasminogen, fibrinogen, fibrinopeptide A and fibrinopeptide Bβ15-42 had changed significantly after each of 3 hemodialyses. Moreover, the concentrations of plasminogen, fibrinogen, fibrinopeptide A, fibrinopeptide Bβ15-42 and fibronectin fluctuated during the period the catheter was left indwelling without showing any definite tendencies. Concentrations of vWF remained high throughout the period of catheterization.
Urokinase immobilized catheters indwelling in femoral veins had no significant effect on systemic clotting or fibrinolysis.

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337 patients on chronic hemodialysis were managed at the Department of Urology, National Defense Medical College, from December, 1978 to June, 1987. Thirty-two of them underwent a total of 43 surgical operations. We discussed 23 urological, surgical, gynecological and orthopedic operations in 21 patients. Hemodialysis was performed the day before surgery.
Preoperative laboratory data were BUN 50±24mg/dl (mean±SD), S-Cr 7.7±3.2mg/dl, S-K 3.5±0.5mEq/l, TP 6.8±1.3g/dl, Ht 27.5±7.8%, Plt 19.9±8.8×10⁴/mm³, pH 7.42±0.04, BE 3±2mmol/l and CTR 53.8±10.3%, respectively. On PO day 1 hemodialysis was performed with regional heparinization. Postoperative complications included hemorrhage in 3, wound infection in 2, peritonitis in 2, hyperkalemia in 2 and obstruction of the A-V fistula in 1. There were no instances of pulmonary edema. Operations could be safely performed in chronic hemodialysis patients using our method.

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The patient was 54y/o male with a 7-year 9-month history of hemodialysis. He was admitted to our medical facility because of chronic fever, cough, chèst discomfort and anorexia. Since he had undergone two surgical excisions for large tumoral calcinosis of the left upper back, and serum C-PTH on this admission was 18ng/ml, secondary hyperparathyroidism was clear-cut in this case. As a result, the diffuse abnormal shadows in both lungs were suspected of representing calcification of the lungs.
This presumption was contradicted by negative accumulation of 99mTc-MDP during whole body scanning.
Antibiotics selected on the basis of the results of sputum culture and sens, itivity tests were administered and intravenous hyperalimentation was also carried out for severe anorexia. The patients general condition and chest X-ray gradually improved and the abnormal shadows on his chest X-ray disappeared completely five months later. Since infectious diseases, especially lower respiratory tract infections, have a tendency to become quite serious in chronic hemodialysis patients, who are compromised hosts, they must always be treated attentively and without delay.

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We classified 113 patients undergoing chronic hemodialysis into 4 types on the basis of renal CT scans performed during the past 5 years for the presence of renal cysts and enlargement of renal shadows.
Type I consists of kidneys without any clear cysts, Type II consists of kidneys with just one cyst, Type III consists of kidneys in which more than 2 cysts are present without clear enlargement of renal mass and Type IV consists of kidneys in which more than 2 cysts are present with clear enlargement of renal mass.
Single variant analysis: In patients in whom many cysts were found and renal mass was enlarged, the period of dialysis was significantly longer and renal calculus and renal calcification were frequently present as complications. In patients in whom cysts were observed, blood β₂-microglobulin (β₂-MG) levels were significantly higher.
There were on significant differences in calcification of the aortic wall, mean blood pressure or RBC among the types.
Mean blood pressure, RBC count, duration of dialysis and blood β₂-MG were used as factors related to classification by means of multivariate analysis.
Hence, it appears that the longer the period of dialysis the more severe the renal lesion. However, whether blood β₂-MG is involved in the onset remains unknown in this study.
Furthermore, since mean blood pressure and RBC count were most closely associated the presence of endocrine action related to the changes in renal morphology arouse our interest.
In this classification the individual types were clearly identified, and the correlation ratio was relatively high at 0.62.

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We evaluated the life activities of chronic hemodialysis patients using a pedometer (Mampo Meter®). The patients were divided into three groups based on the number of steps a day registered on the pedometer. Group I: 13 patients with fewer than 3000 steps per day on both dialysis and non-dialysis days. Group II: 11 patients with fewer than 3000 steps on either dialysis or non-dialysis days. Group III: 23 patients with over 3000 steps on both dialysis and non-dialysis days.
Patients in Group I were significantly older and had undergone significantly longer periods of hemodialysis treatment than those in the other two groups. There were significantly more patients who passed normal stools regularly and easily without laxatives in Group III than in the othero two groups. No significant differences were noted with respect to sex, original disease, occupation, body weight gain between successive dialysis, Ht and CTR.
Sixteen patients were selected from group I and II for excercise conditioning using a pedometer. Each patient was given a goal of daily steps by his/her nurse every week, and the actual steps were checked and recorded. After 3 and 6 months of exersise conditioning, daily steps had increased from 1852±1018 (mean±SD) to 2946±1280 and 3407±1156 on dialysis days, and from 2869±1590 to 4480±1940 and 5098±2762 on non-dialysis days. Although there were no significant changes in the dose of laxatives, degree of water intake, body weight gain between successive dialysis, Ht, CTR, T. Chol, TG or blood pressure after the course, beneficial effects on physical and emotional status such as regained confidence in physical strength, onset of sweating, improved defecation and increased frequency of social contacts with other people were noted in over half of the patients.

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A questionnaire study of constipation was performed in 31 dialysis outpatients.
Seventy-one percent of the dialysis patients suffered from constipation which was more frequent in females and increased with age. All of the laxatives used were of the stimulant-type Some patients used laxatives at several times the usual dose. The majority of the patients became constipated after the institution of dialysis therapy.
Constipation may be attributable to insufficient intake of dietary fiber, the removal of water and electrolytes during dialysis and the ingestion of medicines which may induce constipation.
Constipation was accompanied by malaise, anxiety and abdominal distension.

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The purpose of the present study was to evalute exercise capacity and to investigate the possible introduction of supervised outdoor physical training for chronic hemodialysis (HD) patients. Twenty-four stable HD patients were used as subjects. They attempted to walk a distance of 8075m outside. Before commencing the exercise program, they received a hematological examination, an exercise stress test and an echocardiographsic examination. During the walk their oxygen consumption and number of steps were measured. In addition, walk-induced complications were inquired about after the exercise program. The results obtained were as follows: Ten HD patients completed the walk (C Group), but fourteen HD patients did not (I Group). All patients performed a significant amount of exercise (average=distance walked: 6660m: steps taken: 12704.7: calories burned: 675.4kcal), however their average exercise intensity was rather low (3.25Mets). Distance walked and energy consumed were significantly correlated with maximal oxygen uptake. The mean age of the C Group was significantly higher than the I Group. Many male patients, workers and trained patients completed the walk. Stroke volumes in the C Group were clustered around a mean value of 82.7ml, whereas in the I Group they were dispersed to above 100ml and below 80ml. There were no significant differences between the C Group and the I Group in hematological findings. A total of 20 patients who cooperated were examined using the exercise stress test. Six of these were found to have abnormal electrocardiographic results or abnormal blood pressure response. Untrained patients had pain in their foot joints or muscles after the exercise program.
In conclusion, the present observations suggest that supervised outdoor physical training is beneficial to HD patients.

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A 55-year-old non-insulin dependent diabetic female patient with nephropathy was admitted to our institute for acute myocardial infarction. In spite of intensive cardiac management her condition was complicated by further deterioration of renal function due to massive cerebral infarction and gastrointestinal bleeding during her hospital stay. Hemodialysis was selected for treatment of hypercatabolism because of hemodynamic stability. During the first hemodialysis treatment the patient became comatose, and computed tomography of the brain revealed hemorrhagic cerebral infarction with severe brain edema.
Although the dialysis procedure was switched to continuous peritoneal dialysis after the above episode using the osmotic agents glycerol and mannitol intravenously to remove brain edema, the patient died due to brain stem herniation without recovering consciousness.
Peritoneal dialysis should be recommended not only far patients with cerebral hemorrhage but also for patients with massive cerebral infarction to prevent hemorrhagic infarction and the elevation of intracranial pressure induced by hemodialysis.

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