To investigate the contribution of hemolysis to anemia of peritoneal dialysis patients, we measured serum haptoglobin (Hp) levels in 47 patients on peritoneal dialysis.
The 4 patients (8.5%) whose Hp values were below the measurement sensitivity level (<10mg/dl) were assigned the hemolytic group, while another 43 patients (91.5%) were assigned to the non-hemolytic group. Serum lactate dehydrogenase and reticulocyte counts were significantly higher in the hemolytic group than in the non-hemolytic group (540.0±132.8 vs. 405.5±105.0IU/l, p<0.05 and 28.7±6.6 vs. 18.0±9.0‰, p<0.05). Hemoglobin concentration was significantly lower in the hemolytic group than in the non-hemolytic group (8.73±0.78 vs. 9.83±1.00g/dl, p<0.05). Doses of recombinant human erythropoietin tended to be higher in the hemolytic group (33000±6000 units/month vs. 20230±12490 units/month, p=0.051). However, dialysis duration, serum creatinine, β₂-microglobulin, intact parathyroid hormone, weekly Kt/V and weekly Ccr were not significantly different between the two groups.
The results of this study suggest that hemolysis may be a frequent cause of resistance to recombinant human erythropoietin therapy in peritoneal dialysis patients with anemia.

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Clinical features, treatment and prognosis were studied in 16 systemic lupus erythematosus (SLE) patients on hemodialysis (HD), aged 24-47 years (1M, 15F). Renal biopsy revealed diffuse lupus nephritis (LN) in 12 and membranous LN in 2.
The patients were divided into 3 groups based on the progress of renal dysfunction. Group A (n=6), rapidly progressive, had short duration from the SLE/LN onset to HD introduction and reached renal dysfunction progressively. With low CH 50 and high immunological activity at HD introduction, high-dose steroids were required and combined with plasma exchange therapy in all, and with pulse therapy in 4. The treatment improved immunological abnormalities and renal functions. Group B (n=3), acute on chronic, was treated similarly to Group A. HD was withdrawn but reintroduced in 2, and the remaining 1 patient died suddenly soon after HD withdrawal. Group C (n=7), chronic, included the patients with disease duration as long as 240 or 180 months from the SLE/LN onset. Chronic LN progressed to renal dysfunction. All had diffuse proliferative LN histologically. Hypertension occurred in all and diabetes mellitus in 2. Compared with Group A, SLE activity evaluated with CH 50 at HD introduction was lower (p<0.01), and the steroid doses required (p<0.001) were lower. SLE recurrence in 3 after HD introduction required an increase in steroid doses. One patient died of cerebral hemorrhage after 10 years of maintenance HD.
In Group A, HD was introduced at lower serum creatinine level (p<0.02) than in Group C. Combination with plasma exchange in all and with pulse therapy in half improved immunological abnormalities and renal functions. In Group C, HD was introduced in the “burn-out” state. SLE recurrence during maintenance HD requires close monitoring. HD in SLE patients is introduced under various conditions. Its prognosis may be improved when combined with other therapies at opportune times, considering the findings of laboratory tests and renal biopsy.

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We had an experience of blood purification for an infant with oxalosis. For the small child, a living related liver-kidney transplantation was performed. Over the fifty days between transplantations, hemofiltration (HF) and hemodiafiltration (HDF) treatments were performed to remove oxalate from the patient. Some techniques were introduced to maintain safety. Optimum operating conditions were evaluated from an analytical study. At 1hr after the start of the treatment, the values of urea and β₂-microglobulin clearance were 16.9ml/min and 7.0ml/min, respectively, under 20ml/min of blood flow rate, 40ml/min of dialysate flow rate, and 0.28l/hr of filtrate flow rate. The total amount of oxalate removal was 31.2mg during a 7hr and 40min of HDF treatment. An appropriate treatment for infants with oxalosis can be performed with some devices, taking the low flow conditions into account.

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We report a case of renal pelvic squamous cell carcinoma in a hemodialysis (HD) patient with a catheter indwelled in the renal pelvis.
The patient was a 50-year-old female. She had congenital anomalies of the urinary tract, involving right aplastic kidney and left hydronephrosis due to ureteral obstruction. She had undergone nephrostomy in the left kidney 27 years earlier. She began receiving HD treatment for chronic renal failure 13 years earlier. In March 1998, she noticed gross hematuria. She was referred to our hospital for further examinations in July 1998.
Squamous cell carcinoma of the left renal pelvis was suspected based on the findings of the abdominal CT and the increase of serum level of squamous cell carcinoma-related antigen (SCC-Ag), though urinary cytology was negative. She underwent nephrectomy. Postoperatively, however, she died of mutiple lung metastasis 37 days later. The pathological diagnosis was made because the renal pelvic carcinoma was mostly composed of squamous cell carcinoma.
The incidence of urological malignancies in HD patients is high, and squamous cell carcinoma occurs more commonly in patients with chronic indwelling of a urinary catheter. Therefore, specific attention should paid to such HD patients complaining of hematuria.

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We report a hemodialysis patient with hepatocelullar carcinoma (HCC) that metastasized to the rectus abdominis muscle. A 45-year-old male was admitted to our hospital because of an abdominal mass. Five years before admission, maintenance hemodialysis treatment was started because of end-stage renal failure of unknown etiology. Twenty months before admission, he was diagnosed as having HCC, and was treated with both arterial administration of SMANCS with lipiodol and percutaneous ethanol injection (PEI). Although serum α-fetoprotein (AFP) level was normalized after the treatment, it began to increase again gradually 4 months after the administration. Computed tomography (CT) of the liver revealed no evidence of recurrence of HCC. One month before admission. CT scan of the abdomen revealed a tumor in the rectus abdominis muscle. The tumor was surgically resected and histologically diagnosed as an HCC (moderately differentiated type). There are several reports of patients with neoplastic seeding along the needle track used to carry out PEI. In this case, however, the insertion site of the needle was about 20cm distant from the metastatic tumor in the rectus abdominis muscle. We conclude that this was a very rare case of HCC metastasized to the rectus abdominis muscle.

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The purposes of this retrospective study were to determine what percent of patients who needed hemodialysis treatment traveled in their daily life and to clarify factors that made such patients hesitate from traveling.
This study enrolled 340 patients undergoing hemodialysis treatment at 2 institutions in the Tokyo area. A data collection instrument was developed for this study, which was drawn from the literature, including a demographic data questionnaire, and questions related to experience in traveling, and uneasiness while traveling. The demographic data questionnaire was constructed in such a way as to include variables of age, sex, complications, and years of hemodialysis treatment. The experience in traveling was categorized into times with hemodialysis and without hemodialysis.
Of 340 patients, 311 (91.5%) were involved in the study (86 in institution A and 256 in institution B). Of these, 5 were excluded because they replied incompletely, resulting in a final study population of 306 patients (98.4%). The two institutions did not differ significantly in age, sex, complications, or years of hemodialysis treatment. The patients (age: 53.9±10.5 years; years of hemodialysis treatment: 7.9±6.3 years) who had experienced travel without hemodialysis comprised more than 50%, irrespective of sex or age. The significant factors were consciousness of fatigue, temperance in daily life, and years of hemodialysis treatment. Patients who had experienced travel with hemodialysis were 81, and significant factors were aim in traveling, communication with medical staff members, and experience in traveling without hemodialysis.
This study demonstrated that travel without hemodialysis has become more routine in daily life, although patients are prudent regarding traveling with hemodialysis. This implied that further support by nurses should be required for patients considering travel, as well as keeping in touch with staff members between the proper institutions. In addition, we believe that a warm attitude and goodwill are also important.

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