In this study we performed NHHD using FUT with a dialyzer composed of ethylene vinylalcohol copolymer (EVA) hollow fiber and measured activated coagulation time (ACT) by Hemochron 800 as an index of coagulation time and the concentration of FUT in blood.
Subjects were nine patients treated by regular hemodialysis who had a high risk of bleeding. Six patients were males and three were females. The average age was 49.7±5.0 years old. We performed NHHD a total of 267 times by priming with 1, 000ml of saline including 20mg of FUT and by injecting 10mg of FUT per hour. ACT was measured with a Hemochron 800 manufactured by International Technidyne Co. Ltd. Results: 1. ACT before NHHD was 169.2±2.4 sec, after 1 hour 165.9±2.4, after 2 hours 164.8±3.0, after 3 hours 156.1±2.3, after 4 hours 143.9±4.2 and after 5 hours 165.0±3.1. 2. ACT after 5 minutes was 173.9±3.8, after 10 minutes 169.2±4.0, after 20 minutes 158.3±6.7 and after 30 minutes 160.7±5.0. ACT showed no significant changes during NHHD using FUT. 3. The average concentration of FUT in blood at an injection rate of 10mg per an hour was 67.6±7.7ng/ml. The concentration of FUT after 1 hour was 58.0±14.6, after 2 hours 73.3±14.6 and after 3 hours 70.4±13.9. The concentration of FUT showed no significant changes during NHHD. The concentration of FUT in the arterial chamber prehemodialyzer was 2, 067±224ng/ml and that in the venous chamber 1, 100±150. These results demonstrated that the removal rate of FUT was 47.4±3.8% by hemodialysis and 92.5±1.3% within the body. 4. The average dose of FUT used in NHHD was 10.7±0.3mg/hr by EVA, 17.8±1.6 by PMMA and 16.8±0.5 by cuprophane. The EVA dialyzer used a significantly lower dose of FUT in NHHD as compared with both PMMA and cuprophane dialyzer.
From the above results, it was suggested that NHHD using FUT and an EVA dialyzer was usephul for patients with a high risk of bleeding and that FUT was useful as a localized anticoagulant in non-heparinized hemodialysis.

View full abstract

Rapid high efficiency dialysis (RHED) is an attractive method of hemodialysis for patients. We evaluated RHED from the viewpoint of the physical condition and quality of life of the patients and the working conditions of the paramedical staff by analyzing questionnaires given to ten patients (7 males and 3 females) and seven paramedical staff members (3 technicians and 4 nurses).
The patients on RHED answered that symptoms such as fatigue, loss of appetite and thirst were less than with conventional hemodialysis, and most were satisfied with the shortening of hemodialysis time.
We analyzed the condition of the patients on RHED by GIBS' physical evaluation method and did not find any significant difference in muscle power or physical activity as compared with conventional hemodialysis.
Although the staff was busier during RHED treatment than during conventional dialysis, we noticed that their fatigue was generally decreased by the shortened working time.
We conclude from these results that RHED is an efficient method for both patients and staff.

View full abstract

Risk factors for peritonitis in CAPD patients were studied in 16 CAPD centers in Osaka Prefecture. Subjects were 50 patients introduced into CAPD therapy in 1986 and followed until September 30, 1987 (total 783 patient·months). Twenty-one patients experienced 29 episodes of peritonitis (1 episode/27 patient·months). There was no significant correlation between the frequency of peritonitis and origin of renal failure. The frequency of peritonitis in patients introduced for QOL and rehabilitation, and in those with occupations and housewives was significantly lower than that in cases introduced because of medical problems, or in patients without occupation. These results indicated that patient selection was most important in controlling the frequency of peritonitis.
The judgement of the medical staff was not a good index for patient selection. In patients with occupations, having a CAPD room at the workplace might have decreased the frequency of peritonitis.
The frequency of peritonitis at a renal center experienced in CAPD and having proper nurses and facilities for CAPD was not less than that at other centers. This also seems to indicate the significance of liberal consideration of patient selection standards in terms of prevention of peritonitis. We could not find an index with which to predict peritonitis among clinical examinations for immunological and nutritional status.

View full abstract

A 38-year-old female was referred to our hospital for clinical evaluation and treatment of renal failure associated with hemoptysis. On admission, marked hypoxemia was noted. Chest X-ray showed the patchy distribution of a mottled shadow in the bilateral lower lung, which rapidly extended over the whole pulmonary field within 3 days. Hemoptysis was also aggravated, accompanied by a rise of serum creatinine level from 2.1 to 3.7mg/dl Prednisolone (60mg/day) and plasmapheresis were then instituted. After 3 consecutive plasmaphereses, the abnormal pulmonary shadow and hemoptysis subsided markedly. Creatinine level also decreased to 2.5mg/dl Steroid was then decreased, but plasmapheresis was repeated until chest X-ray findings had improved completely. Renal biopsy was then performed. The biopsy specimen disclosed cresecentic glomerulonephritis by light microscopy and electron dense deposits in the mesangial area by electron microscopy. Intravenous administration of 1.0g of methylprednisolone for 3 consecutive days followed by maintenance doses of 30mg/day resulted in a further decrease in serum creatinine to 1.0mg/dl Anti-GBM antibody was not detected. Therefore, the diagnosis of Goodpasture's syndrome was not substantiated. Nevertheless, it seems likely that plasmapheresis contributed to the favorable outcome of this disease by eliminating some circulating pathogenic factors responsible for pulmonary and renal injury.

View full abstract

Total parathyroidectomy and autotransplantation of parathyroid glands were performed in 13 patients with secondary hyperparathyroidism resulting from chronic renal failure. The rate of preoperative imaging of enlarged parathyroid glands was 48.1% by computed tomography, 61.5% by ultrasonography and 50.0% by ²⁰¹Tl^99mTc subtraction scintigraphy. In addition to parathyroidectomy, removal of the tongue segment of the thymus and resection of the lymph nodes and adipose tissues around the upper trachea and thyroid gland were performed in order to remove supernumerary glands, if any. Four glands were resected in 9 patients, five in 3 and seven 1. Significant correlations were observed between the total weight of resected parathyroid glands and preoperative serum level of the C-terminal segment of parathyroid hormone (r=0.807) and between total weight and preoperative serum level of alkaline phosphatase (r=0.769). Subjective symptoms improved postoperatively in 10 patients, but some symptoms remained in 3 patients.

View full abstract

To evaluate the diagnostic value of the trabecular mineral content of the third lumbar vertebra (LMC) in the diagnosis of renal osteodystrophy (ROD) in patients on chronic hemodialysis therapy (HD), we measured LMC by quantitative computed tomography with standard phantom (QCT), cortical bone mineral content of the metacarpus (BMC), and serum biochemical parameters in 136 HD patients and 147 healthy controls (C).
LMC decreased with increased age in the C and HD groups, but the decreases were different between males and females. BMC decreased with increased duration of hemodialysis. In contrast, LMC increased with the duration of hemodialysis, especially in patients dialysis for more than 10 years. The serum parathyroid hormone concentration (PTH) was strongly correlated with LMC, suggesting a pathophysiologic relationship between PTH and the increase in LMC.
LMC measured by QCT is a useful quantitative diagnostic method to estimate the degree of renal osteodystrophy in HD.

View full abstract

Two cases of purulent pericarditis in the course of chronic hemodialysis are reported.
Both patients were admitted because of persistent fever and exertional dyspnea. Chest roentgenogram showed remarkable enlargement of cardiac silhouette, and cardiac echogram showed a large amount of pericardial effusion in both cases. In one (case 2), the patient died of heart failure soon after admission. In the other (case 1), pericardiocenthesis was performed, and about 450ml of bloody purulent effusion was obtained, which was cultured and led to diagnosis of purulent pericarditis. Pericardiectomy was also performed but in vain. At autopsy, paricardial thickening and fibrosis with multiple abscess formation were found, and small multiple abscesses were also found in the liver and spleen with sepsis.
Effective treatment of purulent pericarditis is based on a combination of appropriate cultures, antibiotics, and surgical treatment.

View full abstract

A double-blind test was performed to determine the effectiveness of human erythropoietin TYB-5220 in 48 renal anemic patients on hemodialysis for chronic renal failure. Hematocrit (Ht) levels increased beginning with the second week of administration, and Δ Ht averaged 7.38±3.75% by the 6th week compared with pre-administration levels (20.66±2.02%) in the TYB group. The reticulocyte count was significantly higher in the TYB group than in the placebo group beginning with the first week of administration. The platelet count was also significantly higher in the TYB group. From the second week of administration subjective symptoms accompanying anemia improved markedly as the Ht level in the TYB group rose, indicating improvement in the quality of life of the anemic patients. As side effects, 3 patients exhibited a rise in blood pressure and 2 patients complained of itching in the TYB group, while one patient showed a rise in blood pressure in the placebo group. These side effects were not severe conditions however, and there was no significant difference in incidence in the two groups. Moreover, clinical test results failed to reveal any clinically significant abnormalities. Based on these findings, in the overall usefulness ratings by the investigator and central committee, ratings of “useful or more” amounted to 87% and 91%, respectiveiy, in the TYB group, and these were significantly superior to those of the placebo group, i.e., 0% in the opinion of both judges. These results suggest that TYB-5220 was highly effective in the treatment of renal anemia.

View full abstract