A new polysulfone dialyzer (BS-1.6UL: BSL), characterized by a longer fiber length and an increased fiberfilling rate, has recently been developed by Toray Medical Co, Ltd (Tokyo, Japan). To determine the significance of the fiber length and the filling rate, the reduction rates of serum low molecular weight proteins were compared among BSL and two conventional dialyzers. The dialyzers tested were BSL, BS-1.6U (BSU, Toray) with a shorter fiber length compared to BSL, and PS-1.6UW (PSW, Kawasumi, Tokyo, Japan), a polysulfone dialyzer with a fiber length similar to that of BSL. In in vitro studies, discarded plasma from end stage renal disease (ESRD) patients and familial hypercholesterolemia patients were dialyzed in a recirculation batch system. The subjects of the clinical studies consisted of six ESRD patients. Both in vitro and clinical studies showed that the reduction rate of low molecular weight proteins was higher in BSL than in other dialyzers, whereas the reduction rate of small molecular substances were similar among the three dialyzers. Adsorption of small proteins and lipids did not significantly differ among the three dialyzers. Leukocyte and platelet counts, and the C3a levels of patients during dialysis did not significantly differ among the three dialyzers. Pressure drop was significantly higher in BSL (BSL>PSW>BSU) both in blood and dialysate compartments. Our results suggest that a longer fiber length and an increased fiber filling rate in dialyzer housing is efficient for the removal of low molecular weight proteins. The efficiency is presumably attributable to the inner filtration rate of the fiber accomplished by the high blood pressure drop in the blood and dialysate compartments.

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Clinical observation of diabetic patients undergoing hemodialysis for more than 10 years in 68 dialysis units in Hyogo prefecture were surveyed using a questionnaire form. Total cases were 30 patients (male: 16, female: 14). The mean age was 62.5±8.0 (SD) years old and the mean duration of dialysis was 15±4.3 (SD) years. As control subjects, 30 non diabetic uremic patients (age and dialysis-history matched) were randomly selected. Blood pressure, fasting blood glucose, and HbA_1C of diabetic uremic subjects were relatively good. General nutritional status was good and anemia was relatively well controlled. The serum level of intact PTH in diabetic subjects was relatively high compared to the reference level and was slightly less compared with that of the non diabetic control, although this difference was not significant. There were only four cases of parathyroidectomy and 9 cases of carpal tunnel syndrome. Among these, 7 cases underwent surgery. Destructive spondylopathy was recognized in two cases. Macrovascular lesions were prevalent in the diabetic group. Occlusion of the lower limb, cardiovascular damage, cerebrovascular accident and history of ischemic heart disease were highly recognized compared with the non diabetic control. Diabetic retinopathy was recognized in all cases, but only 2 cases were blind. The present study shows the treatment of diabetic uremic patients undergoing long-term hemodialysis has remarkably improved in recent years.

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The in vivo generation of proinflammatory cytokines by monocytes is thought to be enhanced in hemodialysis (HD) patients; this process may be associated with acute and chronic complications seen in these patients. However, the acceptability of this hypothesis in view of modern HD treatment is questionable. We addressed this issue by examining cytokine production on a single-monocyte basis using flowcytometry. Eleven maintenance HD patients (mean age, 55±2.3 years old) and 10 age-matched healthy controls were enrolled in the study. The HD patients underwent dialysis treatment using biocompatible HD membranes, such as polysulfone (eight patients) and cellulose triacetate (three patients), and a purified bicarbonate dialysate (containing an endotoxin concentration of less than 1.0EU/L). Two milliliters of peripheral blood were incubated with 15μg/mL of Brefeldin-A and 0.1μg/mL of lipopolysaccharides for 4 hours at 37°C in an incubator under 5% CO₂. Monocytes were labeled with a monoclonal antibody to CD14 (Immunotech), and their intracellular cytokines, such as interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-6 and IL-8 were stained using FASTIMMUNE intracellular cytokine staining kits (Becton Dickinson) according to the manufacturer's protocol. The percentage of cells that stained positive for each cytokine was simultaneously analyzed on a single-cell basis using a flow cytometer (Coulter Electronics). The plasma levels of these cytokiness were also measured in the same blood samples used for intracellular analysis. The following results were obtained: (1) There were no significant differences in the intracellular and plasma levels of monokines between the two groups with the exception of plasma IL-8 and IL-6. (2) HD treatment significantly increased the intracellular production of TNF-α and IL-8, but did not affect any plasma monokine level. In conclusion, the present results suggest that the original interleukin hypothesis does not explain the current state of HD patients who are treated using biocompatible membranes and purified dialysates; however, the present findings do suggest that this hypothesis was true prior to these recent advances in hemodialysis. Activated TNF-α and IL-8 synthesis following HD treatment could be involved with complications commonly observed in chronic HD patients.

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We performed X ray-guided brachial plexus block in the 5 patients (2 male, 3 female) who underwent PTA. In all patients, the block procedure was successfully performed. Pain was well controlled with no complications.

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Complications of atherosclerosis such as ischemic heart disease (IHD) and cerebrovascular disease (CVD) are important prognostic determinants in hemodialysis (HD) patients. We proposed an association between the plasma cardiac natriuretic peptides and atherosclerosis in hemodialysis patients.
We performed echocardiogram and measured the left ventricular mass index (LVMI), and measured brachial ankle Pulse Wave Velocity (ba PWV) using a non-invasive automatic device form PWV/ABI (Nihon Colin Co., AT company, Tokyo, Japan) in 80 patients (40 HD patients, 40 non HD patients), and the correlations with physical and laboratory findings including plasma human natriuretic peptide (HANP) and plasma brain natriuretic peptide (BNP) and complications of atherosclerosis were analyzed.
HANP, BNP, and ba PWV were significantly greater in the HD group than non HD group, and were also significantly greater in the IHD and CVD group than the non IHD and non CVD group. Brachial ankle PWV was positively correlated with systolic blood pressure, mean blood pressure, cardiothoracic ratio on chest X-ray and LVMI in the total, HD and non HD group, respectively. LVMI was positively correlated with HANP and BNP in the total, HD and non HD group, respectively. On univariate analysis, there was positive correlation between ba PWV with HANP and BNP in the HD group. Multiple regression analysis of factors affecting complications caused by atherosclerosis such as IHD and CVD demonstrated that plasma natriuretic peptides were significant.
In conclusion, our study demonstrated that the measurement of the plasma natriuretic peptides could be a useful and sensitive parameter for evaluating atherosclerosis in hemodialysis patients.

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Objective: To investigate the usefulness of Holter electrocardiogram (ECG) recording of periodic limbs movements (PLM) in hemodialysis patients with restless legs syndrome (RLS) for diagnosis of RLS and evaluation of the effects of dopaminergic agent, pergolide mesylate.
Methods: Two hundred thirty hemodialysis patients were surveyed with a questionnaire for RLS and 29 patients were found to have subjective symptoms of typical RLS. Twenty-nine patients were further examined by a neurologist and 23 of those were diagnosed as having RLS. Nineteen of 23 patients were enrolled in the study and 50-100μg of pergolide before sleep was given for 2 weeks. Efficacy of pergolide was evaluated by a change in subjective symptoms measured by visual analogue scale. Holter ECG recording of PLM was performed under suggested immobilized test at the baseline and 2-week endpoint. The sensitivity and specificity of Holter ECG PLM recordings for the diagnosis of RLS were investigated. Correlation between changes in subjective RLS symptoms and PLM frequency was analyzed.
Results: The sensitivity and specificity of positive Holter ECG PLM recording for RLS diagnosis were 65% and 100%, respectively. Twelve of 19 patients completed the study and 7 discontinued due to adverse events Subjective symptoms were improved by approximately 70% by visual analogue scale in all 12 patients and mean PLM frequency significantly decreased from 31.0±7.5 to 5.6±3.0/30min (p<0.05). A significant correlation between changes in subjective symptoms and PLM frequency were noted (r=0.67, p<0.05). Nausea and gastric discomfort as adverse events were observed in 10 and somnolence in 1 of 19 patients.
Conclusions: Holter ECG PLM recording is useful for diagnosis of RLS and evaluation of drug effects. Pergolide mesylate is effective against subjective symptoms of RLS in hemodialysis patients, although it may cause gastrointestinal side effects.

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Light chain deposition disease (LCDD) is a relatively rare condition. It is characterized by multiple organ dysfunction caused by the deposition of light chain protein, production of which is monoclonally increased. We describe a patient with LCDD without multiple myeloma. A 44-year-old woman was admitted to our hospital with rapidly progressive renal dysfunction and anemia. Serum and urine analysis demonstrated monoclonal κ light chain of immunoglobulin G. Immunofluorescence micrography demonstrated κ light chain in the glomerular capillary loops, Bowman's capsules, tubular basement membranes and small vessels. The patient was treated with two courses of melphalan combined with prednisolone soon after the onset of LCDD. After chemotherapy, serum levels of immunoglobulin G and monoclonal protein decreased and further progression renal dysfunction did not seem to develop. However, the patient refused to accept any further immunosuppressive therapy. Two years later, renal dysfunction progressed to end stage renal disease. There after, she was treated by maintenance hemodialysis. Immunosuppressive therapy may effectively prevent renal deterioration during the early phase soon after LCDD onset. Renal function might be preserved for a long time in patients with LCDD by continuing long-term intermittent chemotherapy.

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We present a 70-year-old male on chronic hemodialysis who developed portal-systemic shunt encephalopathy.
The patient has undergone maintenance hemodialysis at our hospital due to diabetic nephropathy since April 2000. On February 26, 2001, he consulted our hospital with complaint of disorientation, somnolence and loss of consciousness. On emergency admission, laboratory data demonstrated a venous blood ammonia level of 282μg/dL (normal: less than 75μg/dL). Abdominal enhanced CT and angiography demonstrated a gastro-renal shunt. Balloon-occluded retrograde transvenous obliteration and drug therapy were performed. Neuropsychological symptom recovered after drug therapy and the venous blood ammonia level was normalized after the obliteration. During a 17-month follow-up, there has been no recurrence of encephalopathy.

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