[Objectives] The inhibitory action of a high-purity eicosapentaenoic acid ethyl ester (EPA-E) preparation on the progression of arterial sclerosis in hemodialysis patients was investigated employing brachial-ankle pulse wave velocity (baPWV) data. [Methods] Among 173 hemodialysis patients consulting our institution between 2004 and 2010, (1) baPWV values in 2010 as classified by patient backgrounds and (2) comparison of baPWV values in groups with and without EPA-E treatment (change in one year and yearly changes for up to six years) were examined retrospectively. [Results] The baPWV values as classified by patient backgrounds were high in cases complicated by diabetes mellitus or hypertension and those with cerebrovascular disease (not significant), and the values were significantly higher in cases with ischemic heart disease. Regarding changes in the mean baPWV in one year, an increased value (+3.0%) was seen in the group without EPA-E treatment (not significant), while there was no change in the group with EPA-E treatment (+0.2%). The mean yearly change rate of baPWV exhibited a significant increase (p<0.05) in the group without EPA-E treatment, while there was no change in the group with EPA-E treatment. [Conclusions] The possibility that yearly baPWV increases in hemodialysis patients can be inhibited by the administration of EPA-E was revealed, and EPA-E was also suggested to be beneficial for inhibiting the onset of cardiovascular events in dialysis patients.

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It has been reported that hemodialysis using acetate-free bicarbonate dialysate (Carbostar containing 3 mEq/L of calcium, 2 mEq/L of citric acid, and 35 mEq/L of bicarbonate), corrects metabolic acidosis and decreases the plasma calcium concentration when changing from bicarbonate dialysate (containing 3 mEq/L of calcium, 8 mEq/L of acetate, and 30 mEq/L of bicarbonate). We examined the change in blood gas analysis and serum calcium in 18 patients undergoing maintenance hemodialysis (HD) using CP. Plasma bicarbonate increased rapidly from 23.1±2.3 mEq/L at the start of HD to 28.7±1.3 mEq/L 2 hours later, and thereafter increased slowly to 30.0±1.1 mEq/L at the end of HD (about 4 hours later). This suggests that the accumulation of the buffer base occurs during HD. Post-dialysis ionized calcium decreased in patients with a high ionized calcium concentration at predialysis, increased in patients with a low calcium concentration, and had a tendency to converge with 1.15 mmol/L at the end of HD. It has been considered that an increase in total calcium during HD is mainly due to an increase in the complex calcium. Calcium mass balance during dialysis was studied in the same patients using the continuous syringe extraction method in dialysate. Mean calcium mass transfer was -37.5±162.9. The mean calcium mass transfer related to diffusion was 160.6±144.7. The mean calcium mass transfer related to diffusion was inversely correlated with the predialysis plasma total calcium(r=-0.61, p<0.01). The mean calcium mass transfer related to ultrafiltration was -327 to -83.753 (-198.0±67.3). The negative calcium balance mainly depended on ultrafiltration. The patients were classified into low (i-PTH<60 pg/mL), normal (i-PTH 60-180 pg/mL), and high (i-PTH>180 pg/mL) PTH groups based on measurement of the intact PTH during the previous year of treatment with bicarbonate dyalysate (containing 3 mEq/L of calcium, 8 mEq/L of acetate, and 30 mEq/L of bicarbonate). Then, changes of i-PTH and plasma Ca levels were compared between before and after changing the dialysate to CP. In all three groups, the plasma calcium concentration at the end of dialysis decreased after changing the dialysate to CP. Plasma calcium concentrations before dialysis in normal and high PTH groups did not change. The plasma calcium concentration before dialysis in the low PTH group was higher than that in the normal PTH group before changing the dialysate, but it decreased significantly after changing the dialysate to CP. The plasma i-PTH level increased in the normal and low PTH groups. It was considered that the cause of the increase in PTH of the low PTH group depends on the relatively low concentration of plasma calcium during HD and decreased plasma calcium before HD, due to the improvement of calcium regulation which occurred by the correction of metabolic acidosis.

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As a shortage of kidney donor exists, there is a trend toward an increase in ABO-incompatible kidney transplants in Japan. The removal of anti-A anti-B anti-blood type antibody is primarily necessary for ABO-incompatible kidney transplants, and double filtration plasmapheresis (DFPP) is usually performed before transplant. DFPP contains various albumin concentrations as replacement fluid: 7.5%, 1,500 mL; 8.3%, 1,800 mL; 9.0%, 2,500 mL; and 10%, 2,000 mL. The rates of change for antibody titers and procedure side effects were analyzed. In the results of this study, a lower concentration of albumin tended to be associated with nausea, vomiting and a lower blood pressure. All patients underwent kidney transplantation successfully, and titer reduction did not differ in the groups. In order to avoid the procedural side effects and reduce the appropriate antibodies titer, a higher albumin (9.0～10.0%) concentration should be encouraged before ABO-incompatible kidney transplants.

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A 78-year-old man who had been suffering from kidney disease due to membranous nephropathy was admitted to our hospital in May 2010. On admission, exacerbation of heart and renal failure was noted. Hemodialysis was initiated. During hospitalization, he needed respiratory management with a ventilator twice for respiratory failure. Tube feeding was started because dysphagia developed after extubation. His general condition gradually improved. Six months after admission, he showed elevated liver and biliary enzymes. Abdominal ultrasonography showed point-like, highly echogenic images in the portal vein, and abdominal computed tomography (CT) revealed dendritic low-density areas in the lateral segment of the liver, suggesting hepatic portal venous gas (HPVG). In addition, CT showed intramural gas in the stomach and contact between the stomach tube and gastric wall. On gastroscopic examination, diffuse mucosal damage was observed, and an ulcerous region coincided with the area where the tube contacted the gastric wall. Based on these findings, the damage caused by the tube to the gastric wall was thought to be associated with the development of HPVG. After diagnosis, the tube was removed and antibiotics were administered. Thereafter, liver and biliary enzymes normalized within three weeks. HPVG occurs due to various causes. Here, we report a rare case of HPVG caused by a stomach tube.

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