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.

A strong earthquake (magnitude 6.8) off the Sea of Japan struck the Chuetsu area of Niigata Prefecture on July 16, 2007. By way of investigating the impact of the earthquake on the health of maintenance hemodialysis patients, we examined several biochemical parameters including nutritional markers and psychological stress markers and checked up on the incidence of earthquake-induced complications (heart failure and shunt obstruction). Blood samples were collected and the values of several biochemical parameters were measured. Incidences of clinical complications one, three and six months after the quake were scrutinized. Significant decreases in the nutritional markers and a significant increase in the incidence of complications were found one month after the quake. During this period, the supplies of electricity, city gas and water were completely recovered one after another. The significant changes in the nutritional levels and the incidence of complications coincided with the time of the complete recovery of these utilities. The levels of these parameters recovered and the incidence of complications reduced three months after the quake. However, the serum albumin level did not recover and remained significantly lower even six months after. The psychological stress markers increased significantly three months after. These suggested that there was the time lag between the decrease in the nutritional markers, the increase in the incidence of complications (1 month after earthquake) and the increases in the psychological stress markers (3 months after earthquake). We concluded that these findings provided important information for the total medical plan to maintain the physical and psychological states of hemodialysis patients in an earthquake- stricken district.
month ; Complications Specific to Antepartum or Postpartum ; Earthquakes ; incidence of cases ; Hemodialysis

Recent studies showed that high biocompatibility and reduction of uremic toxin contributed to the improvement of freatment outcome in hemodialysis patients.Therefore, a high-flux membrane dialyzer, especially polysulfone (PS) membrane, was generally used in dialysis. However, it was suggested that the higher efficiency of reduction in uremic toxins might cause an increase in the albumin leakage through the dialyzer membrane during dialysis, resulting in a decrease in serum albumin concentration. In this study, we used two different dialyzer membranes with high biocompatibility, namely, ethylenevinylalcohol (EVAL) membrane and improved PS membrane with a very lower leakage of serum albumin. After using these two types of mambrane of six straight months, we examined the effect of each dialyzer membrane characteristic on the serum total protein and albumin concentration. The reduction rates of each uremic solute and serum total protein concentration were significantly higher. The serum albumin concentration and its rate of change with the passing of time tended to increase in the case of the PS membrane. But in the case of EVAL membrane, these values tended to decrease. These results suggested that the differences in the changes in the serum total protein and albumin concentration might result from the differences in the efficiency of the reduction of uremic toxins. Therefore, it is necessary to consider the usage of the dialyzer membrane with a higher reduction of uremic solutes and a lower leakage of serum albumin to add to the higher biocompatibility specially in hemodialysis patients with hypoproteinemia.
Membranes ; Concentration ; Reduction (chemical) ; Serum Albumin ; Hemodialysis

We experienced a case of severe alcoholic hepatitis. Combination treatment of continuous hemodiafiltration and steroid hormone was started immediately after admission. This treatment was very effective for severe alcoholic hepatitis, resulting in the shortening of the length of hospital stay. The reasons why this treatment was effective were; 1. The patient was younger, so the regeneration ability of liver cells was stronger. 2. The infection and bleeding of digestive organs except for acute renal failure were not found, resulting in the enhancement of the effectiveness for steroid hormone treatment. 3. The intensive blood purification treatment was started immediately. From this experience, we realized again that a fine collaboration of doctors, nurses and clinical engineers was very important in the intensive care of the severe diseases.
therapeutic aspects ; Steroid hormone, NOS ; Hepatitis, Alcoholic ; Combined ; Review [Publication Type]

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.

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.

Increasing medical knowledge and improved hemodialysis techniques have permitted longer survival in patients receiving hemodialysis. However, the risk of cardiovascular disease, which is mainly caused by atherosclerosis, substantially increases in proportion to the longer survival of hemodialysis patients. At present, cardiovascular disease is a major cause of morbidity and mortality. The present study was designed to investigate the relations between electrocardiographic abnormalities (e.g. ischemic change, left ventricular hypertrophy, arrhythmia and conduction block) and the progression of atherosclerosis, the atherosclerotic risk factors (e.g. diabetes, hypertension, hyperlipidemia and smoking) and aortic calcification in patients on maintenance hemodialysis. Pulse wave velocity (PWV) was used as the index of atherosclerosis. PWV levels were singficantly higher in ischemic change (1,993±99cm/s), left ventricular hypertrophy (2,103±120cm/s), arrhythmia (2,015±120cm/s), and condition block groups (2,014±119cm/s) than in the nomal group (1,627±69cm/s). Also, PWV levels corrected by diastolic blood pressure in all abnormal groups were significantly higher. Serum Creactive protein levels in all abnormal groups also tended to be higher than those in the normal group. With regard to atherosclerotic risk factors, the incidence of diabetes and hypertention tended to be higher in abnormal groups. Especially the incidence of hypertension was significantly higher in ischemic change (66.7%), left ventricular hypertrophy (50.0%) and conduction block groups (55.6%) than that in the normal group (16.7%). These results suggest that the electrocardiographic changes are related to the progression of atherosclerosis, and among atherosclerotic risk factors, hypertension most affects the electrocardiographic changes in patients on maintenance hemodialysis.
Hemodialysis ; Atherosclerosis ; seconds ; Ventricular hypertrophy ; Hypertension induced by pregnancy

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

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.