Previously, we have reported that Candida strains were morefrequently detected in the oral cavity of hemodialysis patients, particularly long-term patients, than in that of the patients with chronic glomerulonephritis ans conservative chronic renal failure. In the present study, we conducted a screening test for the prevalence of serum Candida antigen in hemodialysis patients and determined Candida species in the oropharyngeal portion of those with serum Candida antigen. Serum Candida antigen was found in 18.75% of the hemodialysis paients in our renal unit. Furthermore, Candida strains were detected in the oropharyngeal portion in 75.0%of those with serum Candida antigen. The percentage was higher than that of hemodialysis patients without serum Candida antigen (50.0%). Candida species determined in the oropharyngeal portion of the hemodialysis patients with serum Candida antigen were C. albicans (66.7%), C. glabrata (55.6%), C. krusei (11.1%), and C. parapsilosis (11.1%). There were no significant differences in age, hemodialysis periods, and the serum values of the nutrional markers (serum total protein, albumin, transferrin, and total cholesterol) between the hemodialysis patients with serum Candida antigen and those without. Generally, it is well known that hemodialysis patients are theso-called immunocompromised host. Therefore, it is necessary to examine serum Candida antigen and to determine Candida species in the oropharyngeal portion, wherewas first possible portion of mycotic infection, beforehand so as to predict the occurrence of invasive Candidiasis

It is known that the cerebral circulation is regulated spontaneously and always keep blood flow constant despite changes in perfusion pressure. This phenomenon has been called the autoregulation of cerebral blood flow. However, there is still considerable controversy regarding the influence of blood viscosity upon cerebral blood flow. Several studies have reported that in hemodialysis patients, the velocity of middle cerebra artery (MCA) blood flow decreased after hemodialysis, resulting from the decrease in body fluid and the increase in blood viscosity. In the present study, we evaluated changes in MCA blood flow velocity by hemodialysis in the patients with end-stage re -nal disease referred for hemodialysis due to chronic glomerulonephritis (CGN group) and diabetic nephropathy (DN group). No stenoses of the carotid artery were comfi rmed by ultrasonography in all subjects. We measured MCA blood flow velocity before and after hemodialysis using a 2-MHz pulsed-wave transcranial Doppler instrument with on-line spectrum analysis. Additionally, the measurements of mean blood pressure, body weight, hematocrit levels and arterial blood gas were made simultaneously. In the CGN and DN groups, mean MCA blood flow velocity was 52-56cm/sec and 49-53 cm/sec before hemodialysis and 51-53cm/sec and 51-53cm/sec after hemodialysis, respectively. No significant decreases in MCA blood flow velocity after hemodialysis were found in both groups, though body weight in both groups and mean blood pressure in the DN group alone decreased while pH, HCO₃^-, and Ht levels in both groups increased significantly. PCO₂ and pO₂ levels remained unchanged. Also, no significant differences were found between both groups in the changes in MCA blood flow velocity. Pulsatility and resistive indices in the DN group were relatively higher than those in the CGN group. This result suggests the more progression of arteriosclerotic changes in MCA in the DN group compared with those in the CGN group.

It is known that the reabsorption of filtered HCO₃^-depends on the tubular flowrate in the proximal uniferous tubule. In animal experiments, studies have demonstratedthat, when diuresis was induced, the pH of the collecting duct urine decreased, resulting from the decrease in HCO₃^-concentration with no change in the pCO₂ level.The present study was designed to examine changes in urine acidification in humansunder a water diuretic state. Urine pH, pCO₂ levels, and HCO₃^-concentration weremeasured before and after the drinking of water. In 120 minutes after hydration, theurine pH level fell about 0.5 pH unit from that before the intake of water. The urine HCO₃^-concentration coincidentally decreased significantly. However, pCO₂ values remainedunchanged. These results indicated that also in humans, water diuresis promotesurine acidification, resulting from a decrease in HCO₃^-concentration with nochange in the pCO₂ level, which may contribute to the prevention of the loss of plasmaHCO₃^-into the urine when the urine flow rate increases.

Accelerated atherosclerosis has come to pose a great threat to the lives of hemodialysis patients. In the present study, to determine the characteristics of atherosclerosis in long-term survivors on maintenance hemodialysis (mean age : 57±3 years, mean duration of hemodialysis : 279±11 months), the reference to clinical, biochemical and physiological parameters pertaining to atherosclerosis were examined and the results were compared with those in age-matched short-term hemodialysis patients (mean age : 55±2 years, mean duration of hemodialysis : 23±3 months). Although hypertension is regarded as one of cardiovascular risk factors together with diabetes, smokings and hyperlipidemia, our study found that the incidence of hypertension was significantly lower in long-term survivors on hemodialysis (16.7%) than in short-term hemodialysis patients (83.3%). However, no significant differences in biochemiacal data and carotid artery intima-media thickness were found between the two groups of hemodialysis patients. Levels of pulse wave velocity (PWV) in both short-term hemodialysis patients (1912±165 cm/sec) and long-term survivors on hemodialysis (1627±97 cm/ sec) were significantly higher than those in age-matched healthy subjects (1382±44 cm /sec). The levels of PWV in long-term survivors on hemodialysis tended to be lower than those in short-term hemodialysis patients, although the difference was statistically not significant. These results suggest that atherosclerotic alterations have already advanced in non-dialyzed patients with end-stage renal disease. The relatively lower levels of PWV in long-term survivors on hemodialysis may reflect the higher incidence of cardiovascular-related complications in those patients with highly accelerated atherosclerosis who die or may drop out during hemodialysis treatment.
Hemodialysis ; Atherosclerosis ; Age, NOS ; month ; Cardiovascular

It is considered that hepatitis C virus (HCV) infection may be a pathogenic factor in cryoglobulinemia and glomerulonephritis. The purpose of this study was to determine whether there is any relation between the presence of hepatic disorder due to HCV infection and the association with cryoglobulinemia and urinary abnormalities, i. e. proteinuria and/or hematuria, in HCV-infected patients. Cryoglobulinemia was found in 11.4% of our HCV patients. However, seropositivity of cryoglobulin detected in all the patients was low. The prevalence of the association with cryoglobulinemia in patients with hepatic disorder was significantly higher than that in patients without hepatic disorder. Urinary abnormalities were found in 10.0% of the HCV patients. No significant difference was observed in the prevalence of urinary abnormalities between patients with and without hepatic disorder. In addition, there was no significant difference in the prevalence of urinary abnormalities between the association with and without cryoglobulinemia. These results suggest the close relation between the presence of hepatic disorder due to HCV infection and the association with cryoglobulinemia. However, renal involvement may have no relation with the presence of hepatic disorder and cryoglobulinemia.

This study focused on the local hemodynamic changes created by hemodialysis therapy in the forearm with arteriovenous fistulas for hemodialysis. Arteriovenous fistulas were created in the distal site of the forearm in all the patients who participated in this study. We measured the blood flow volume and blood flow rate in the arteriovenous fistulas using the Doppler ultrasonic flowmeter, and oxygen saturation using the pulse oxymeter and wave height using the plethysmogram in all the fingers of the forearm with arteriovenous fistulas as makers of local hemodynamics before and after hemodialysis therapy was given. After hemodialysis therapy, the patients' body weight reduced by an average of 2.5kg. Reduction of body weight (body fluids) led to decreases in mean blood pressure (99±4 vs. 80±5mmHg) and increases in heart rate (68±2 vs. 72±3 bpm) and hematocrit level (35±1vs. 38±1%) compared with those before hemodialysis. Furthermore, the reduction of body weight tended to decrease the blood flow volume and blood flow rate in arteriovenous fistulas. However, no significant changes were found in blood flow volume and blood flow rate in arteriovenous fistulas between before and after hemodialysis. We further studied the changes in oxygen saturation and wave height in all the fingers of the forearm with arteriovenous fistulas. No significant change was found in oxygen saturation between before and after hemodialysis. However, wave height tended to decrease after hemodialysis.These results suggest that the changes in body weight (body fluid), blood pressure, heart rate, and blood viscosity created by an usual hemodialysis therapy less affect the local hemodynamics in the forearm with arteriovenous fistulas.

Prior to the anticipated initiation of hemodialysis, the state of mind of patients with chronic renal failure is emotionally unstable. They are weighed down with anxiety. Recently, we started the once-a-week initiation method of hemodialysis in order to lighten the psychological burden in our renal unit. This study was disigned to examine the state of mind of patients receiving hemodialysis as well as the effect of the once-aweek initiation of hemodialysis on the state of mind. The psychological burden wasfound in 83.3% of patients. Particularly, the restriction of food and water intake (39.1%), the restriction of actions by repeated hemodialysis (20.9%), and the fear of complications and the anxiety about the future (15.5%) accounted for 75.5% of all psychological burdens. The initiation of hemodialysis once a week reduced various psychological burdens, the restriction of food and water intake (30.7%), the restriction of actions by repeated hemodialysis (23.1%), physical complications and the lowering ofphysical faculty (23.1%), the changes in the domestic position and role (15.4%) and the economical and social restriction (7.7%), in 72.2% of patients. These results indicate the necessity of the psychological counseling for the prognosis before the start of hemodialysis and the consideration for the choice of the initiation method of hemodialysis.

Patients with chronic renal failure (CRF) have a great psychological burden before they start hemodialysis and when the treatment begins. We initiated once-a-week hemodialysis program, designed to reduce the psychological burden as well as to keep the residual renal function. A total of 13 CRF patients with an adequate urine volume participated in this program. Nutritional counseling was done in all the patients. They were on hemodialysis for five hours at a time. The blood flow rate of more than 200ml/min was secured. Dialyzers with the largest filtering membrane area possible were used, the physique of the patients taken into due consideration. The weekly hemodialysis treatment was continued, so long as the levels of serum urea nitrogen, serum creatinine and body weight gain were lower than 100 mg/dl, 13.0mg/dl, and 3.0kg/week, respectively. Pre-dialysis urine volume and creatinine clearance were 1, 370±160ml/ day and 4.7±0.4ml/min, respectively. The hemodialysis treatment continued for 25±5 times. There were no significant correlations between the duration and pre-dialysis levels of urine volume, creatinine clearance, serum urea nitrogen, serum creatinine, hematocrit, arterial blood pH and HCO₃^-. Hemodialysis were discontinued when there were increases in body weight (7 patients), the increase in solutes (3 patients), and both (3 patients). The average monthly medical expenses involved in once-a-week hemodialysis was 55.1% of those entailed by hemodialysis treatment three times a week. Once-a-week hemodialysis is suitable for the conditions: 1. Patients have an ad quate urine volume and no severe edema. 2. Serum urea nitrogen and creatinine levels are not extremely high. 3. Patients fully comply with their dietitian's advice. 4. Shunt blood fl ow is kept enough. Provided these conditions are met, our study suggested, once-aweek hemodialysis should be considered as one of the treatment options, because it was proved effective in reducting CRF patients psychological burden, maintaining residual renal function, and cutting medical costs.

At present, among the types of viral hepatitis, hepatitis C virus (HCV) appears to be the major cause of hepatitis in hemodialysis units. Previously, we took blood samples from the blood tubing at the inlet and the outlet of different dialyzers and measured serum HCV-RNA levels in hemodialysis patients with HCV. We found a significant reduction in serum HCV-RNA levels through the use of a polymethylmethacrylate (PMMA) membrane in dialysis. In the present paper, we report on a case in which HCV was extinct during hemodialysis treatment. The patient was a 72- year-old woman. The duration of hemodialysis was 259 months. The biochemical findings revealed high levels of serum alkaline phosphatase and TTT. The data of other liver enzymes were within normal range. The serum HCV-RNA level, which had been tending downward, was 32 KIU/ml, when the dialyzing membrane was changed to a PMMA membrane. Thereafter, the serum HCV-RNA level further reduced and reached below 0.5 KIU/ml in 12 months. This result suggests that HCV reduction efficiency should be considered when dialyzing membranes are selected from among many.

  A ground rule of dialysis support in the event of massive earthquake disaster is to perceive the necessity of evacuating patients quickly and to have a system fully equipped to collect information as to the situation of the designated disaster hospital in a region and other facilities and the capacity to take care of patients. Furthermore, building a network incorporating dialysis facilities in the neighboring areas is essential. Through this network, efforts have to be made to work out a practical dialysis support program without delay (annular support system). It is also important to create a support scheme which does not impose an excessively heavy burden on the staffs of damaged facilities. To put it concretely, the following measures should be taken:(1) to reduce the time needed for the transfer of patients to the mimimum;(2) to make the length of the patient's stay at a support facility the shortest possible;and (3) to get the data of dialysis patients ready and share the records with other dialysis facilities. To make the cooperative framework for tiding over a major earthquake disaster, it is important to establish the annular support system of dialysis facilities between the quake stricken area and its neighboring area. If a similar annular support system is not installed in many areas, cooperation does not function well. We must consider the ways and means to establish an ideal cooperative regional disaster prevention system in preparation of a large-scale earthquake, which may occur any time, while drawing a lesson from the previous earthquake disasters.