We conducted a cross-sectional nutrient intake survey of chronic hemodialysis(HD) patients to determine the current status of those at high risk for protein-energy wasting(PEW). The subjects were 160 outpatients receiving HD at medical facilities in Saga and Hyogo Prefectures and 82 healthy volunteers living in Saga Prefecture. The intakes of all nutrients were significantly lower in HD patients than in the healthy volunteers. However, the lipid energy ratio was significantly higher in HD patients than in the healthy volunteers. The proportions of HD patients who met dietary reference values for chronic kidney disease(CKD) were: 45.6% for energy intake, 16.2% for protein, 32.5% for salt, 18.8% for water, 63.1% for potassium, and 80.6% for phosphorus. Thus, nutrient intakes were inadequate in most HD patients. Those with adequate energy and protein intakes comprised only 13.7%, while energy and protein intakes were both insufficient in 40.0% of patients and protein intake alone in 20.6%. These findings indicate that a high percentage of patients are at high risk for PEW. In conclusion, many HD patients are at high risk for PEW. We advocate that the nutrient intakes of these patients be periodically evaluated. They should also be given nutritional guidance/management with a strong educational value.

View full abstract

Patients requiring hemodialysis have a variety of dialysis-associated complications. In particular, hypotension, which is a potential complication of chronic hemodialysis patients, unexpectedly occurs during treatment and interrupts the continuation of dialysis, creating a feeling of distress for patients. In light of stabilizing the blood pressure during dialysis, we have focused on the venous return as a factor leading to the stabilization of blood volume changes(ΔBV) and investigated the possibility that accelerated venous return results in maintaining the blood pressure during hemodialysis. The subjects of this study were 18 hemodialysis patients on maintenance hemodialysis. We used a sequential pneumatic compression massage tool(foot pump) to accelerate the venous return during hemodialysis. The venous return was accelerated by continuous massage with the foot pump during hemodialysis. Conditions of the massage were classified into 4 categories: condition 1 was no massage(control), condition 2 was slight massage, condition 3 was hard massage, and condition 4 was automatic massage. Values of ΔBV and blood pressure were observed under these conditions. As a result, a more significant stabilization of ΔBV and the blood pressure in hemodialysis sessions with massage was noted compared to sessions without massage. Sensory changes were also studied and compared: pre-dialysis, post-dialysis, and after returning home. In condition 2, significantly more favorable results of sensory changes were obtained after than before dialysis. Consequently, this research showed that the prevention of dialysis-induced hypotension by accelerating the venous return is feasible.

View full abstract

In Japan, the number of chronic dialysis patients is increasing each year, with those continuing hemodialysis therapy for 25 years or more accounting for 3.8% of all dialysis patients. Long-term dialysis patients tend to develop malnutrition, which needs to be corrected by appropriate nutritional management. To establish optimal nutritional management that enables patients to continue long-term hemodialysis therapy, we reviewed data on 48 dialysis patients (25 males, 23 females) who had continued hemodialysis therapy for 25 years or more to examine intra-individual changes in the physical condition, nutrient intake, and blood biochemistry results at the beginning of hemodialysis therapy and 15 and 25 years after its introduction. On the basis of the results, we identified the nutritional characteristics of these patients. Then, to ascertain the nutritional characteristics and problems specific to long-term dialysis patients in general, we compared the obtained results with those of the National Health and Nutrition Survey conducted in age-matched subjects during the same period as the present study. The nutritional characteristics of dialysis patients continuing dialysis therapy for≥25 years were as follows: (1)reduced muscle mass while the BMI was maintained at around 20kg/m²; (2)decreased energy and protein intake, which is not specific to dialysis patients; (3)energy and protein intakes lower than those specified in the dietary recommendations for chronic kidney disease(CKD) 2007, although activities of daily living(ADL) were of the “Requires occasional assistance, but is able to care for most of his needs” level. In addition, serum calcium and phosphorus levels were effectively controlled within normal ranges. The most important findings in this study were that, while energy and protein intakes were decreased below the levels specified in the dietary recommendations for CKD, serum albumin levels were 3.8±0.3g/dL and Karnofsky Performance Scale scores were 80.8±10.3. This analysis of the nutritional characteristics of patients continuing dialysis therapy for ≥25 years while maintaining ADL yielded important information and highlighted issues to be addressed for the improved nutritional management of dialysis patients.

View full abstract

The patient was a 65-year-old man. At the age of 50 years, hemodialysis was introduced due to chronic renal failure secondary to IgA nephritis, and ever since, he has been on outpatient dialysis. At 63, he developed lymphadenopathy of the left posterior neck. The node was excised and examined. Histopathological examination revealed anaplastic large cell lymphoma(ALCL). Although it was anaplastic lymphoma kinase(ALK) -negative ALCL, which is generally thought to be highly malignant, this patient had no other remarkable lesions; therefore, he was followed up without treatment. There have since been no lesions, and the patient was alive with no recurrence at the 2-year follow-up.

View full abstract

For maintaining favorable vascular access, it is important to improve the puncture technique and puncture without error. In our clinic, we have made an effort to reduce vascular access mispuncture from three years ago. This time, we examined the frequency, cause and situation regarding the mispuncture of arteriovenous shunts over a 1-year period. All punctures for arteriovenous shunts in chronic hemodialysis patients were studied from January to December 2010. The miss notebook in which mispunctures had been recorded was utilized for an investigation of mispuncture. It was judged to be a mispuncture when one of the arterial or venous side veins failed in the first puncture. The mispuncture was classified by time of occurrence into the following three groups : (1)consecutive miss, (2)miss within one week, (3)sporadic miss. The total number of dialysis procedures employing arteriovenous shunts was 15,101 and the number of dialysis procedures involving a mispuncture was 215 (1.4%). This low rate is regarded as the effect of the previous effort to avoid mispuncture. Based on the classification, consecutive misses numbered 15(7%), misses within one week numbered 19(9%), and sporadic misses, the majority, numbered 181(84%). There were few consecutive misses and misses within one week. This may be due to the effect of reporting the contents of the miss notebook to the medical staff in the morning conference on the next dialysis day. In addition, sporadic misses, comprising the majority of mispunctures, were related to the poor concentration of medical staff. We think that it is possible to reduce sporadic misses by maintaining concentration during puncture.

View full abstract