Each year The Japanese Society for Dialysis Therapy has run a questionnaire survey on the status of the chronic dialysis patients in Japan. Accumulated data as of December 31, 1990 were as follows. The response rate was 97.6%, and dialysis for such patients was conducted at 2, 101 facilities, up 21.1% from the previous year. Chronic dialysis patients numbered 103, 296 in all, among which 73, 868 were treated in the day and 24, 806 at night. There were 35 patients on home dialysis, 45, 36 on CAPD and 51 IPD treatment. Patients numbered 835.7 per million population and showed straight-line growth. In 1990 new patients beginning treatment were 18, 441 and death occurred in 8, 936 patients. Patients increased by 9, 474 that year, and male patients (59.1) outnumbered female patients (40.8). The mean age was 54.03 years for males and 54.26 for females, reflecting an increasingly higher mean age.
Chronic glomerular nephritis (64.1%) was the basic disease, followed by diabetic nephropathy (14.9%), polycystic kidney (3.3%), nephrosclerosis (2.6%), and pyelonephritis (2.2%). Deaths were due to cardiac insufficiency (30.4%), cerebrovascular disorders (13.9%), infectious diseases (11.6%), malignoma (8.2%), and myocardial infarction (5.6%). Survival rates for one to seven years were 0.833, 0.758, 0.698, 0.649, 0.608, 0.583, and 0.559, respectively. The survival rates for 7 years for basic diseases were as follows: chronic glomerular nephritis 0.655, diabetic nephropathy 0.322, polycystic kidney 0.667, nephrosclerosis 0.308, and pyelonephritis 0.553.
Thus, with increasingly older patients and those suffering from complications refractory to treatment, more sophisticated treatment and greater care are required.

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Nerve conduction velocity (NCV) is considered to be an indicator of adequate dialysis. Patients receiving CAPD may be less susceptible to developing uremic neuropathy than those undergoing hemodialysis (HD), as the former removes middle molecular weight substances more efficiently than the latter. The present study was conducted to assess serial NCV changes in 22 non-diabetic patients receiving CAPD for a period of 72 months. NCV was also compared in CAPD and HD patients over the 48-72 months following the initiation of dialysis therapy. Linear regression analysis showed a slight serial decrease in NCV in CAPD patients, which was statistically significant in both the motor and sensory components of the median nerve. No significant changes were observed in any other nerves. The observed NCV chorges appeored to be less severe in CAPD than in HD patients, because HD patients showed significant decreases in SCV as compared to CAPD patients. There was no correlation between NCV and plasma concentrations of low molecular weight substances.
In conclusion, CAPD patients show a slight but significant decrease in NCV over the course of long term observation.

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In order to analyze problems arising from the initiation of hemodialysis (HD) in elderly patients, we conducted a study of 87 such patients. Subjects included 47 males and 40 females, all of whom were treated by HD during the 10-year period from 1981 to 1990. All of the patients were over 70 and their mean age was 76.3 years. The ongoing renal diseases were nephrosclerosis in 44, chronic glomerulonephritis in 19, diabetes in 12, polycystic kidney in 4, pyelonephritis in 4 and other diseases in the remaining 4 cases.
HD was initiated in 8 patients who were clinically asymptomatic. In the other cases, the initiation of HD was required to treat azotemia, oliguria, heart failure, hyperkalemia, acidosis, anasarca, appetite loss, etc. One month later, 26 of these patients had died, the prognosis was maintenance of HD in 58, and HD had been discontinued in 3. At one year, however, a total of 56 patients had died. The patients who died within one month were characterized by lower blood pressure, decreased urine volume, higher BUN levels and acidosis. Most of these patients had multiple organ failure, infection and coagulopathy. Among the 30 patients with no organ failure, however, there was only one death.
These data suggest that in elderly patients early initiation of HD, before the onset of organ failure, will improve both long and short term prognoses.

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Dialysis patients should be drilled in how to handle emergencies. We have conducted such drills at our hospital. Fifteen dialysis patients participated in these drills. We took them off dialysis 8 times in order to evacuate them during these simulated emergencies. After re-connecting the dialysis equipment, we recorded the length of time required for evacuation to a safe place.
The results of these tests showed that the time required by the patients became progressively shorter. This type of drill was thus demonstrated to be very beneficial for dialysis patients in the event of their needing to be evacuated from the hospital for any reason.

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A 53-year-old man with essential mixed cryoglobulinemia type III presented with nephrotic syndrome. Endocapillary proliferation, intraluminal thrombi and diffuse thickening of the glomerular besement membrane with a double contoured appearance were seen on renal biopsy. Cryopheresis, in conjunction with steroid and immunosuppressive therapy, led to disappearance of proteinuria and purpura.

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A 58-year-old male diabetic patient who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 9 months was hospitalized because of astasia and abasia in September, 1990. Marked asterixis was observed in all extremities and the tongue at the time of admission. The electroencephalogram (EEG) showed diffuse slow waves. After the volume of peritoneal dialysate was increased, asterixis decreased and the gait disturbance was ameliorated. In December, 1990 the patient was readmitted because of peritonitis due to infection of the exit site of the catheter. CAPD was temporarily suspended and hemodialysis was performed for treatment of the peritonitis. During this period, the neurological symptoms recurred. After a new Tenchoff catheter was reinserted, the volume of the peritoneal dialysate was gradually increased and amelioration of asterixis and gait disturbance was obtained. During the second episode of neurological disorders and hemodialysis treatment, the serum aluminum level was not abnormally elavated either at baseline or at 48 hours after desferioxamine infusion.
We consider the recurrent astasia and abasia in this case to have been of central nervous system origin, i.e uremic encephalopathy caused by inadequate dialysis.

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