Along with increases in age as well as survival of dialysed patients, factors other than Ca and inorganic P seem to contribute to the development and progression of vessel calcification. Among such factors, lipids are considered to be the most important.
Aortic calcification can be evaluated semi-quantitatively by CT in terms of the Aortic Calcification Index (ACI). We reviewed here, the progression of aortic calcification over 4 years in terms of ΔACI, and analyzed the interrelationship between each plasma lipid including oxidized LDL and ACI in 55 hemodialysed patients.
The subjects were 55 patients maintained on hemodialysis. ACI was measured between 1993 and 1997. ACI increased progressively with a high significance as follows: 18.3±18.3 at 1993, 27.6±22.5 at 1995 and 33.2±24.6 at 1997 (p<0.0001). There was no significant correlation between ACI and plasma lipid such as TG, IC, LDL-C, HDL-C, OX-LDL, Lp (a), or RLP-C.
All patients were divided into 2 groups according to the level of ΔACI as follows: low ΔACI group (<3.5, 28 cases), and high ΔACI group (>3.5, 27 cases). There were no differences in age or the duration of HD between the two groups. Patients in the high ΔACI group had significantly higher OX-LDL and Lp (a) levels than those in the low ΔACI group (p<0.05).
Our findings suggested that percitipation of OX-LDL as well as Lp (a) occurs with vessel calcification, as well as atherosclerotic change.

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We evaluated he efficacy of articular injection of triamcinolone acetonide to patients complaining of joint pain associated with dialysis-related amyloidosis. Nine patients received injection of steroids to the shoulder joint and 6 of them showed a good response. In these 6 patients, relief of pain continued for 6 weeks. The steroids were administered every 4.3 months thereafter, for 2.8 years. This dose of steroids was equivalent to 0.3mg prednisolone per day. No side effects were seen in these patients.
In conclusion, administration of triamcinolone acetonide to patients with dialysis-related amyloidosis was effective.

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We studied the effects of vitamin K₂ administration on the bone metabolism of hemodialysis patients. Subjects: The subjects were 53 hemodialysis outpatients (26 men and 27 women) ranging in age from 29 to 79 years (average: 59.6±11.3). The duration of hemodialysis treatment ranged from 1.3 to 17.9 (average: 5.8± 3.6) years. Results: 1) The i-PTH value significantly increased after vitamin K₂ administration in patients with pretreatment levels less than 60 pg/ml (n=38). However, patients with i-PTH levels of 60 pg/ml or over (n=15) before administration showed no significant change. 2) The vitamin D₃ concentration showed no significant change. 3) i-OC levels significantly increased in patients with pretreatment i-PTH level less than 60 pg/ml (p=0.0388). 4) ICTP levels were significantly decreased (p=0.0005) in patients who showed low pretreatment i-PTH levels, less than 60 pg/ml. 5) Vitamin K₂ was detected in only 5 of 53 patients before treatment. The values increased after treatment. 6) The serum calcium and phosphorus concentration showed no significant change. 7) The prothrombin ratio significantly increased 9 months and significantly decreased 12 months after treatment (p=0.0102, p<0.0001), but remained within normal levels. No shunt trouble was observed. These findings suggested the tendency of decreased vitamin K₂ levels in hemodialysis patients and vitamin K₂ administration can improve their bone metabolism turnover.

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It is well known that autosomal dominant polycystic kidney disease is very frequently accompanied by intracranial aneurysm. We used magnetic angiography (MRA) screening to facilitate early detection of such unruptured intracranial aneurysm. Consequently, 6 lesions suspected of being intracranial aneurysms were found in 23 patients. Of these, excluding two patients, one of whom did not give consent and one of whom was pregnant, 4 patients underwent angiography and 4 intracranial aneurysms ranging from 4 to 8mm were found in the vertebral artery, bifurcation of internal carotid and ophthalmic artery respectively and 2 aneurysms were found in the middle cerebral artery. Clipping surgery and embolization were performed in 2 patients and one patient, respectively. MRA, a noninvasive method, was useful in screening for intracranial aneurysm.

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Between January 1995 and August 1998, low calcium dialysis (low Ca HD) at a Ca concentration of 1.5mEq/l was administered to 3 cases of multiple myeloma and 1 case of rectal cancer with hypercalcemia. All cases were associated with renal failure. The serum Ca level before administration of low Ca HD ranged from 10.5mg/dl to 16.8mg/dl, and clinical symptoms included headache, loquacity, lumbago, appetite loss, and clouding of consciousness. Three patients received a bisphosphonate agent. The number of low Ca HD ranged from 2 to 14 episodes. In the cases that effectively responded to a combination of low Ca HD and bisphosphonate agent, the serum Ca levels and general condition immediately improved. On the other hand, in 1 case, the serum Ca levels could not be controlled by low Ca HD and medication. We propose that low calcium dialysis is effective therapy for emergent cases to quickly reduce serum Ca levels and improve the clinical symptoms.

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Sclerosing encapsulating peritonitis (SEP) is one of the most serious complications of continuous ambulatory peritoneal dialysis (CAPD) and is associated with a high mortality rate. We report here, the successful surgical management of three patients with this complication of CAPD. The first case was a 35-year-old male who was treated with CAPD for 7 years and had 5 episodes of peritonitis. The second case was a 50-year-old female who was treated with CAPD for 10 years and had no episodes of peritonitis. The third case was a 43-year-old male who was treated with CAPD for 8 years and had 2 episodes of peritonitis.
All subjects had their bowel encased with a thick, fibrotic membrane. These patients were treated surgically by peeling the membrane away from the intestines and each showed a good outcome.
In the past, the surgical management of SEP was considered to produce poor results unlike our findings. We consider the surgical management of SEP to be a very useful strategy for treating SEP.

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A 53-year-old female with chronic renal failure who had undergone regular hemodialysis through a radialcephalic arteriovenous fistula on her right arm, visited our outpatient clinic complaining of a pulsatile tumor in the right arm. The tumor, measuring 7×3cm, was found at the central portion of the left anterior arm where the fistula had been made. Color Doppler ultrasonography revealed an aneurysm from the radial artery under the fistula. The next day, the tumor enlarged, so an emergent operation was performed under the diagnosis of a ruptured aneurysm. The aneurysm was resected and direct end-to-end anastomosis of the two divided arteries was made. The patient recovered uneventfully and hemodialysis was restarted on the first postoperative day. Microscopic examination of the aneurysm revealed only fibrous and scarring changes, so the diagnosis of a pseudoaneurysm was made.

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We reported a case of uremic pericarditis treated by thoracoscopic pericardiectomy. A 64-year-old women underwent maintenance hemodialysis twice a week from October 1989 because of end-stage diabetic nephropathy. She was admitted complaining of dyspnea and chest pain. Chest roentgenography revealed cardiomegaly and echocardiography confirmed massive pericardial effusion. Although intensive dialysis combined with hemodiafiltration, pericardiocentesis and instillation of triamcinolone hexacetonide into the pericardiac cavity were performed, pericardial effusion did not decrease. Left thoracoscopic pericardiectomy was performed under general anesthesia on February 14, 1997 and dyspnea and chest pain diminished. However, moderate pericardial effusion was detected by echocardiography 4 months later, and right thoracoscopic pericardiectomy was performed on August 19. Following treatment, no symptoms remained.

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