The pharmacokinetics of intravenously and intraperitoneally administered aztreonam (AZT) were evaluated in continuous ambulatory peritoneal dialysis (CAPD) patients. 1) One gram of AZT was intravenously administered in 3 CAPD patients without peritonitis (Group 1) and intraperitoneally administered in 3 other CAPD patients (Group 2). After the administration, the time-course of the plasma AZT concentration was monitored by high pressure liquid chromatography. Pharmacological parameters were calculated based on the 2-compartment model in Group 1 and the 3-compartment model in Group 2. 2) 0.5g of AZT was repeatedly administered intraperitoneally in 6 CAPD patients with peritonitis, and their AZT plasma concentration was monitored on the third and fifth days. T1/2 in Group 1 was prolonged by 7.40±2.57hr, and it is suggested that the dose and/or interval of AZT administration should be carefully controlled. Tmax in Group 2 was 4.28±0.72hr, and rather rapid movement of AZT in serum was shown. In the repeated administration of AZT for patients with peritonitis, accumulation of AZT was not observed by 120hr, except for one case without residual renal function. It is concluded that the pharmacokinetics of AZT in CAPD patients is affected by residual renal function and that the dose and/or interval of AZT should be determined according to residual renal function.

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In order to analyze problems arising from the initiation of hemodialysis (HD) in patients having low creatinine levels (under 8mg/dl), we conducted a study in 110 such patients. The subjects included 43 males and 67 females, all of whom were treated by HD during the 10-year period from 1981 to 1990.
The ongoing renal diseases were diabetes in 37 patients, nephrosclerosis in 32, chronic glomerulonephritis in 23, amyloidosis in 9, systemic lupus nephritis in 3 and other diseases in the remaining 6 patients. HD was initiated in 26 patients in the mild stage of clinical symptoms.
In the other patients, initiation of HD was required to treat heart failure, oliguria, hyperkalemia, anasarca, acidosis, and appetite loss. At the end of one month, 22 of the patients had died, 80 patients were being maintained on HD, and HD had been discontinued in 8 patients. By the end of one year, however, a total of 59 patients had died.
The patients who died within one month had multiple organ damage, and their prognosis was related to the degree of organ damage. The prognosis was especially poor in patients with multiple organ damage, severe infection, and coagulopathy. There were no deaths, however, among the 29 patients who had no organ damage. Considering the clinical symptoms, these data suggest that early initiation of HD before the onset of organ damage, even if the level of creatinine is under 8mg/dl, will improve both the long-term and short-term prognosis.

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It has been proposed that ANP may be a suitable clinical marker for determining the appropriate body fluid state in patients on maintenance hemodialysis (HD). To address whether this holds true for diabetic (DM) patients on hemodialysis (HD), measurement of ANP was performed in dialyzed DM patients for comparison with non diabetics (non-DM).
1) There were no differences in pre-ANP, post-ANP values, body weight, CTR, and blood pressure between non-DM and DM patients. 2) A significant relationship was found between %decrease in body weight induced by HD and reduction in ANP in non-DM patients, but not DM. Similarly, a significant relationship was found between % decrease in BW and %decrease in ANP in non-DM patients, but not in DM patients.
These data suggest an abnormal secretary behavior of ANP in patients with DM. The abnormality may be accounted for by an underlying diabetic complication including myocardial damage. It is, thus, concluded that ANP can not be used as a clinical marker for body fluid state in hemodialyzed patients with DM.

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Conventional VPA (C-VPA) therapy during hemodialysis has been reported to be accompanied by dramatic changes in valproic acid levels, and this has been suggested as a reason for the occurrence of convulsions immediately after hemodialysis (HD). We report three pediatric patients with chronic renal failure on HD successfully treated with sustained-release valproic acid (SR-VPA) preparations for their seizure disorders. In order to evaluate the mechanism of SR-VPA effects in these patients, changes in serum concentrations of total VPA (T-VPA), free VPA (F-VPA) and the free fraction of VPA (FF) were determined using a fluorescence polarization immunoassay. Pre-HD levels of the FF of SR-VPA were significantly higher in our patients, as reported previously. Although the FF of SR-VPA changed during HD and was lowest immediately after HD was completed, similar to the C-VPA findings in the previous literature, T-VPA levels were stable during and after HD treatment. Therefore, F-VPA levels were kept within the therapeutic range during and after HD, when F-VPA was rapidly reduced and out of the therapeutic range in the case of C-VPA. Considering the above findings as a whole, we conclude that SR-VPA maintains the therapeutic range of F-VPA during and after HD with resultant clinical efficacy.

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We performed renal angiography in 11 hemodialysis patients who had renal cell carcinoma.
Tumor vessels or tumor staining was observed in every case. No adverse effects were noted.
Renal angiography provided clear demonstration of both hypervascular tumors and feeding arteries, when regular enhanced CT scans showed masses with equivocal contrast enhancement in acquired cystic disease of the kidney.

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We studied the effect of a synthetic eelcalcitonin analog (Elcatonin: ECT) on changes in bone mineral content in 61 patients with renal osteodystrophy undergoing chronic hemodialysis (32 males and 29 females; mean age: 51.1±12.8 years, mean duration of hemodialysis: 10.4±4.4 years). The patients were given a 40-IU infusion of ECT during each hemodialysis session for 12 months, and their bone mineral content was evaluated every 6 months. We determined the bone mineral content of the parietal bone and the 3rd lumbar vertebra by dual energy X-ray absorptiometry (DEXA) using an X-ray bone densitometer (QDR-1000/W, HOLOGIC Co., Ltd., USA). ECT administration caused an significant increase in the bone mineral content of the parietal bone, which is a cortical bone, but no significant change in the lumbar vertebra, a spongy bone. ECT administration significantly increased the bone mineral content of the parietal bone in patients with low bone mineral content and high PTH levels before ECT therapy. However, there does not appear to be any correlation between bone mineral content and the duration of hemodialysis.
ECT therapy also significantly decreased ALP and OH-Pro levels, but did not affect PTH or ALPiso levels.
These findings suggest that increases in bone mineral content by ECT are often observed in cortical bone in hemodialysis patients and that ECT has an inhibitory effect on bone absorption and an action which increases bone mineral content. On the other hand, determination of bone mineral content by DEXA is thought to be a useful method for the diagnosis of renal osteodystrophy and the evaluation of therapeutic effects.

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It is well-known that outflow obstruction due to encasement of dislocated catheter tips is one of the most serious complications in patients undergoing CAPD. Many researchers have reported the incidence of migration of catheter tips to be 15-20%.
In order to clarify the incidence of migration of catheter tips and examine whether there is a relationship between the position of catheter implantation and the occurrence of migration, we evaluated the location of the catheter tip every 2-3 months using plain abdominal X-rays in 100 patients undergoing CAPD with lateral placement of peritoneal catheters in Tokai University Hospital.
In all 100 cases, catheter tips were consistently located out of the pelvic cavity in 5 (5%), temporarily out of the pelvic cavity in 19 (19%) and in the pelvic cavity in 76 (76%). Fifty-two cases underwent implantation of a swan-neck catheter on the right side of the umbilicus. The catheter tips were consistently located out of the pelvic cavity in 3 (6%), temporarily out of the pelvic cavity in 12 (23%) and in the pelvic cavity in 37 (71%). Forty-eight cases underwent implantation of a swan-neck catheter on the left side of the umbilicus. The catheter tips were consistently located out of the pelvic cavity in 2 (4%), temporarily out of pelvic cavity in 7 (15%) and in the pelvic cavity in 39 (81%).
There was no significant relationship between the position of implantation of the peritoneal catheter and the incidence of migration. Surgical intervention was required 3 cases within 14 days after implantation. There was no relationship between the exit direction of peritoneal catheters and the incidence of migration.
In conclusion, we observed that the incidence of migration of peritoneal catheter tips was 24%. However, 2 weeks after the implantation of peritoneal catheters, no patient showed obstruction of in-outflow due to encasement of the omentum or required surgical intervention. No patient showed any relationship between the exit direction of a peritoneal catheter and the incidence of migration.

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Attention was directed to Cepharanthin's inhibitory effects on cytokines and dismutating superoxide radicals. Its effects on leukocyte counts in peripheral blood, production of superoxide anions by neutrophils and concentrations of TNF-α, IL-1β and IL-8 were studied during hemodialysis.
Preliminary studies confirmed that 1) production of superoxide anions by neutrophils was enhanced by recombinant human TNF-α and recombinant human IL-8 and 2) zymosan-induced production of TNF-α and IL-1β by neutrophils was inhibited by Cepharanthin.
At the start of hemodialysis, 20mg of Cepharanthin was administered, and various parameters were determined before administration, and 15min and 4 hours following administration.
Cepharanthin was not effective in preventing hemodialysis leukopenia, but did inhibit the activity of neutrophils producing superoxide anions.
The mechanism of inhibition could not be explained by the clinical data of these cytokines. But from the results of preliminary studies, it was suggested that Cepharanthin suppressed the priming effect on neutrophils which was enhanced by these cytokines.

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A hemodialysis patient associated with metastatic gastric calcification is reported.
A 49-year-old man who had undergone hemodialysis for eighteen years complained of epigastralgia, and erosive gastritis was diagnosed by gastrofiberscopic examination. Furthermore, calcification was pointed out on the biopsy specimen of the gastric mucosa. Bone scintigram also showed uptake in the stomach. In order to investigate gastric motility, gastric emptying time was examined, but it was not delayed compared with other patients.
Metastatic visceral calcification is recognized as one of the complications of uremia, but no reports have mentioned the clinical impliance of metastatic gastric calcification. In this case, the endoscopic diagnosis was gastric erosion with some bleeding. Gastric motility was not disturbed in this study, but further follow-up study is considered necessary.

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A method of blood purification which has the least adverse influence on the cardiovascular system is needed in patients with decreased cardiac function. We report the case of a 70-year-old man diagnosed with diabetic nephropathy who had renal failure and experienced an acute myocardial infarction. This patient developed anuria due to the low-output syndrome (LOS). Nevertheless, when treated with IABP therapy and catecholamine infusion, he recovered from the LOS, but not from the anuria. He was then treated with continuous hemodialysis (CHD) while his cardiac and respiratory function was unstable, and with peritoneal dialysis (PD) after those functions had stabilized. During blood purification, the patient's cardiovascular status became less serious.
We conclude that CHD and PD have little effect on the cardiovascular system.

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A 40-year-old female who had been on hemodialysis for 12 years developed secondary hemochromatosis because of a large number of blood transfusions (over 40l of blood during the 11 years before treatment with erythropoetin).
Deferoxamine was administered to this patient (40 times in total) and HPM dialyses were simultaneously performed in order to prevent irreversible damage to the internal organs due to iron deposition. After treatment, the serum ferritin level was reduced from 7, 800 to 187ng/ml, and the liver CT index had decreased from 108.5 to 81.7. Improvement was also observed in the levels of hemoglobin A₁ (12.5 to 5.6%), hemoglobin A₁C (11.2 to 4.6%), GOT (62 to 29IU) and GPT (71 to 19IU). In conclusion, combined use of deferoxamine and HPM dialysis appears to be effective in hemochromatosis due to multiple blood transfusions.

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A case of brachial vein stenosis is reported. A 56-year-old man with an arteriovenous shunt placed for hemodialysis had massive swelling of the ipsilateral upper extremity following the onset of cervical OPLL. He had had a subclavian vein catheterization for temporary blood access 5 years before. He was successfully treated with percutaneous transluminal angioplasty followed by endovascular stenting with a Spiral Zigzag stent.

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