Objectives: It is necessary to elucidate related structures among the emotional status and other influences on hemodialysis (HD) patients to develop a program to support and maintain their emotional well being. To identify factors that influence the emotional status of HD patients, the Kidney Disease Quality of Life Short Form (KDQOL-SF) was utilized in this study. Methods: Self-administered questionnaires by KDQOL-SF were obtained from 206 patients consisting of 161 outpatients (day dialysis 37, evening dialysis 124), and 45 inpatients. The mean age of subjects was 54.1±11.5 years, and the mean duration of HD history was 102.1±86.6 months. Results and Discussion: The variables identified as factors that influence emotional well-being of HD patients were outpatients and patients with current employment (Wilcoxon rank sum test), current income (Kruskal-Wallis test), serum albumin of 3.6g/dl or above, serum potassium of 5 to 5.5mEq/l, and hematocrit of 25% or above (the analysis of variance). These data suggested that HD patients with higher activity and better nutrition could be regarded as having better emotional well-being. The multiple regression analysis showed Role-Physical (standard beta=0.227, p<0.001), Social Function (standard beta=0.216, p<0.001), Sleep (standard beta=0.189, p<0.001), General-Health (standard beta=0.145, p<0.05), Quality of Social Interaction (standard beta=0.121, p<0.05) and Effects of Kidney Disease (standard beta=0.114, p<0.05) as significant independent variables. Especially, less restricted physical and social function and high quality of social interaction were more strongly associated with emotional well-being than other independent variables. Thus, it is crucial to maintain good social interaction to maintain their emotional well-being. Conclusions: The outpatient, the patient with current employment, current income, serum albumin of 3.6g/dl or above, serum potassium of 5 to 5.5mEq/l and hematocrit of 25% or above demonstrated better emotional well-being. These patients were less restricted by physical functional problem and social functional level. Better sleep quality had a strong influence on the positive emotional well-being of the patients.

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Uremic patients have two opposite features in hemostatic status, that is, bleeding and thrombophilic tendency. Platelet functions for normal hemostasis are impaired, possibly contributing to the bleeding tendency in uremic patients. In contrast, platelet hyperaggregability and hypercoagulability that are commonly observed in uremic patients may be associated with their high incidence of thrombotic diseases. Recent studies suggested that platelet microparticles (PMPs) which are small vesicles with procoagulant activity released from the activated platelets might be relevant to thrombogenesis. This research investigated this hemostatic paradox in uremia by analyzing the characteristics of PMPs in circulation.
The subjects were patients under hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD), and healthy controls. The PMPs analysis was performed using a flow cytometer. The procoagulant and adhesive activities of PMPs were specially determined by their expressions of Annexin V and P-selectin, respectively. The influence of HD procedure and arterio-venous (A-V) fistula on PMP formation were also assessed. The counts of total PMPs and PMPs with procoagulant and adhesive activities were statistically greater in both uremic groups, but those PMP counts did not differ between the uremic groups. The HD procedure and A-V fistula did not affect the PMP formation. In conclusion, the elevated PMP counts may be responsible for the thrombotic tendency in uremia despite impaired platelet function.

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We conducted a prospective randomized comparison of a cuffed graft (Venaflo^®) with a conventional polytetrafluoroethylene graft (Carboflo^®) with respect to the incidence of venous stenosis and patency. Sixty patients were assigned randomly to implantation with a Venaflo^® (Venaflo^® group) or Carboflo^® graft (Carboflo^® group). Mean age, gender distribution and diabetic and hypertensive status did not significantly differ between the two groups. At 6 and 12 months, primary patency rates were 42.6% and 29.0%, respectively, in the Venaflo^® group and 72.6% and 42.9%, respectively, in the Carboflo^® group. At 6, 12, and 18 months, secondary patency rates were 86.4%, 77.6%, and 77.6%, respectively, in the Venaflo^® group and 96.6%, 90.5%, and 84.1%, respectively, in the Carboflo^® group. There were no significant differences between the two groups in primary and secondary patency rates. Postoperative fistulogram performed 3 months postoperatively showed significant venous stenosis in 12 of 20 Venaflo^® grafts and in 11 of 21 Carboflo^® grafts. We conclude that the Venaflo^® does not have a favorable effect on primary and secondary patency rates or reduction of venous stenosis.

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To evaluate the effectiveness of low-calcium dialysate in hypoparathyroidism, twenty-nine cases of hypoparathyroidism was divided into two groups; Thirteen patients with absolute hypoparathyroidism (A-Hypo; intact PTH<60pg/ml) and sixteen patients with relative hypoparathyroidism (R-Hypo; 60≤intact PTH<160pg/ml). And maintenance hemodialysis was switched from conventionally normal calcium (Ca: 3.0mEq/l) to low-calcium (Ca: 2.5mEq/l) dialysate. During the one-year observation period, their serum calcium levels were decreased and intact PTH levels were increased significantly in either group. However, serum ALP levels were increased only in R-Hypo, and were not changed in A-Hypo. Serum ALP levels in all patients were significantly correlated with bone-specific ALP (r=0.94) levels. These findings suggest that absolute and relative hypoparathyroidism showed the distinct response patterns to hemodialysis therapy with low-calcium dialysate and might reflect the difference in pathogenesis between the two hypoparathyroidism groups in dialysis patients.

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We report a 65-year-old male admitted to our hospital due to consciousness disturbance. He had been on hemodialysis for 18 months and complicated with liver cirrhosis developing into hepatic encephalopthy. On admission, he was disoriented and waved his arms wildly. Laboratory data revealed an ammonia level of 281μg/dl. There were no significant findings on brain MRI. Despite the administration of branched chain amino acid and lactulose, consciousness did not improved. Serum potassium pre- and post-hemodialysis were 3.5mEq/l and 2.6mEq/l, respectively. There were no other factors worsening encephalopathy (constipation, gastrointestinal bleeding, portal-systemic shunt and so on) were not detected, hemodialysis using dialysate increased potassium concentration (3.5mEq/l) was started. Ten days after treatment, consciousness was restored and his condition has remained good ever since. This finding indicates that hypokalemia can also cause hepatic coma in a hemodialysis patient with liver cirrhosis and that potassium-modulated dialysis may be an effective treatment for these patients.

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A 52-year-old man, receiving maintenance continuous ambulatory peritoneal dialysis (CAPD) for about 1 year was admitted to our hospital for chief complaining of fever up and general fatigue. Abdominal computerized tomography (CT) and ultrasonography (US) revealed multiple liver tumor and serum alpha-fetoprotein (AFP) was elevated. On further examination, the clinical diagnosis was gastric tumor. CAPD was discontinued and changed to hemodialysis (HD). Distal gastrectomy was performed. Histopathologic diagnosis was poorly differentiated adenocarcinoma. Serum AFP dropped postoperatively. Postoperative diagnosis was alpha-feto-protein producing gastric cancer.

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Accumulated clinical evidence has shown that the oral administration of tranexamic acid (TA) could increase ultrafiltration (UF) volume. However, the clinical consequences of long-term prescription of TA remain unclear. This paper reports three patients who were given low dose TA intermittently (500mg×3days/week) for up to 18 months. During the study period, there were no major adverse effects relating to TA administration, In all cases, a sustained increase in UF volume was observed. In the peritoneal function according to peritoneal equibulation test, there was no change found in one case, while increased permeability was found in two cases. These results may indicate that the long-term intermittent administration of low dose TA is clinically effective in terms of increasing UF volume. Thus, this agent could be used for patients with UF failure instead of a higher glucose level solution. However, the exact effect of TA for the peritoneal function remains unclear, and needs further study.

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