Kenji Sawanishi

Serum and corpuscular nickel and zinc in chronic hemodialysis patients

Serum and corpuscular nickel and zinc concentrations in 30 chronic hemodialysis patients were examined. Serum nickel and zinc levels before dialysis were 0.22 +/- 0.03 microgram/dl (normal value: 0.56 +/- 0.08 microgram/dl) and 70.0 +/- 13.4 micrograms/dl (normal value: 96 +/- 8 micrograms/dl) low, respectively. However, corpuscular nickel and zinc levels before dialysis were high: 1.25 +/- 0.24 microgram/dl (normal value: 0.88 +/- 0.17 microgram/dl) and 1,299 +/- 146 micrograms/dl (normal value: 1,120 +/- 80 micrograms/dl). Serum zinc levels significantly increased after dialysis, but serum nickel concentrations did not significantly increase during dialysis. Corpuscular nickel and zinc concentrations did not significantly change during dialysis.

Serum Copper Concentration Changes in Chronic Hemodialyzed Patients

We studied the behavior of copper during hemodialysis and the relationship between serum copper levels and hematologic parameters such as red blood cell count (RBC), hematocrit (Hct), hemoglobin (Hb), and serum iron in 48 hemodialyzed patients. To study diffusion, we measured copper in the arterial blood and in the dialysate at the inflow and outflow sites of the dialyzer. To study hemoconcentration, the change in hematocrit values and total serum protein values were examined. To study liberation of copper from the dialyzer membrane, copper concentrations in normal saline were measured before and after the saline was used to wash dialyzers of various kinds. We found that changes in serum copper concentration were due mainly to hemoconcentration and liberation, but partly also to diffusion, and that the net result of changes was a significant increase in serum copper. We observed no correlation between serum copper levels and RBC, Hct, Hb, and serum iron levels.

Two-Compartment Model of Cholesterol Kinetics for Establishment of Treatment Strategy of LDL Apheresis in Nephrotic Hypercholesterolemia

Cholesterol kinetics in the time course after LDL apheresis using a dextran sulfate cellulose column was analyzed by adapting a two-compartment cholesterol kinetic model. Fifteen sets of serial serum cholesterol concentrations after LDL apheresis from 4 patients with drug-resistant nephrotic hypercholesterolemia due to focal glomerulosclerosis (FGS) were analyzed and cholesterol kinetic parameters were estimated with the nonlinear least-squares method. The fractional cholesterol catabolic rates (Kc; 0.171 +/- 0.073/day, mean +/- SD) were markedly decreased as reported in familial hypercholesterolemia (homo: 0.101/day, hetero: 0.280/day). Cholesterol generation rates (G; 68.0 +/- 28.7 mg/dl/day, mean +/- SD) considerably overlapped the normal range (39.2-77.5 mg/dl/day). This result was compatible with an earlier report that Kc was reduced earlier than G in nephrotic hypercholesterolemia. The time average serum cholesterol concentrations (TAC) in the rebound phase after LDL apheresis can be simulated using these kinetic parameters by the Runge-Kutta-Gill method. According to our previous report, TAC must be reduced to under a near-normal level in order to obtain a beneficial effect on nephrotic syndrome due to FGS. In 10 sets out of the 15, once-weekly treatment of LDL apheresis was sufficient to achieve this aim, but in the remaining 5 cases, more frequent LDL apheresis up to twice a week was necessary in the early phase of treatment. In conclusion, the two-compartment cholesterol kinetic model is useful in clarifying the abnormal cholesterol kinetics in nephrotic syndrome and may be helpful in establishing a more rational strategy of LDL apheresis for nephrotic hypercholesterolemia.

Relationship between haemodialysis anaemia and copper and zinc

In fifteen chronic haemodialysis patients, serum and corpuscular copper and zinc concentrations were examined before and after dialysis. Serum copper levels were normal before dialysis and elevated after dialysis. However, corpuscular copper levels were low before dialysis and did not change after dialysis. Serum zinc concentrations before dialysis were low and significantly increased after dialysis. Corpuscular zinc levels before dialysis were high, but were unchanged after dialysis. There was a good correlation between serum zinc levels and red blood cell counts (RBC) and the value of haemoglobin (Hb), whereas we found no significant correlation between levels of serum or corpuscular copper and zinc, and of RBC, Hb, haematocrit or serum iron.

Zinc Transfer during Hemodialysis in Chronic Renal Failure Patients

We examined zinc transfer during hemodialysis and serum zinc concentrations of hemodialyzed patients. 10 outpatients were studied during a single dialysis and 6 hospitalized patients were monitored during a week-long series of dialysis. Serum zinc concentrations increased significantly by diffusion and hemoconcentration after 5-hour dialysis. In 6 hospitalized patients, the daily protein and calorie intake were measured to examine the relationship between serum zinc and diet. We found a good correlation between serum zinc concentrations and total serum protein or daily calorie intake.

Aluminum transport and dialysance during haemodialysis

Aluminum transfer and dialysance during haemodialysis and plasma aluminum concentrations in haemodialysis patients were examined. Plasma aluminum in 30 volunteer outpatients tended to decrease after 5-hour dialysis (6.35±3.02 μg/dl before haemodialysis; 5.41±2.60 μg/dl after haemodialysis). The decrease was mainly due to diffusion despite haemoconcentration evidenced by a significant increase in the haematocrit and total plasma protein during dialysis. To study the changes resulting from diffusion, we measured aluminum in the arterial blood and in the dialysate at the inflow and outflow sites of the dialyzer. There was a non-significant decrease in the plasma aluminum of arterial blood from 6.20±2.90 to 5.64±2.55 μg/dl, but a significant increase in the dialysate aluminum from 0.38±0.18 μg/dl to 1.10±0.66 μg/dl. Aluminum diffused across the dialyzer from the blood to the dialysate in 23 cases and into the blood in 7 others. When aluminum dialysance is high, plasma aluminum can be removed to the dialysate during haemodialysis.

Relationship between serum nickel concentrations and anaemia in chronic haemodialysis patients.

Thirty chronic haemodialysis patients were examined with respect to the relationship between renal anaemia and serum nickel concentrations. Red blood cell counts, haemoglobin values, haematocrit values, serum iron values, serum ferritin levels and serum nickel concentrations were measured.No significant relationships were found between serum nickel levels and serum iron values or serum ferritin levels.Dialysis anaemia was found to have a significant correlation with serum nickel concentrations in chronic haemodialysis patients.

Prevention of Microcytic Hypochromic Anemia in Chronic Hemodialysis Patients

Dialysis anemia is one of the severe complications in chronic hemodialysis patients. A high-aluminum dialysate causes microcytic hypochromic anemia in hemodialysis patients by aluminum intoxication. W

A research on the actual condition of the diet control in the hemodialysis patients

透析患者の社会復帰率を高める要因の1つに食事管理がある. 透析食を何年位でマスターするかを知るために, 透析患者139名を透析導入後1年未満A群15.8% 1-2年B群31.7% 3-4年C群22.3% 5-9年D群25.2% 10年以上E群6.4%の5群に分類し, その実態を比較検討した. 食事に対する心構えは透析歴を問わず十分にみうけられ, 水分や塩分摂取過剰の目安となる体重の増加に対してほぼ全員が注意し, 水分や塩分の制限には5年以上になると透析食をマスターしているためか苦痛にせず食事管理を行っていた. のどの渇きを強く意識し, それを我慢している率は3年以内で70%と高く, 3年以上では40%に低下し, 長期になる程口渇を意識せず日常生活の一部として水を飲みながら体重管理は十分に行っていた. 高K血症には果物・嗜好品の摂取制限や調理法の工夫により対処し, 食事摂取状況では非透析日に良好なのが目立ち, 食欲は透析歴の浅い者程透析により影響を受け, 長期になると透析は患者の生活のサイクルの一部になってきていると思われた. 家族は患者に協力的で, 家族全体が患者と同じ物を食べており, 患者本意の食生活が窺えた. 以上のことから, 食事の自己管理にA群では戸惑いながらも努力しているが, B・C群では透析にも慣れたためか怠満やルーズさが目立ち, D・E群では透析療法及び透析食を自己のものとしてきている傾向が明らかにみられた. そして, 長期透析患者の食事管理には, 問題の有無にかかわらず, 常に患者とのコミニケーションを保ち, 再々繰り返し指導することが重要であると思われた.

A Simple Method of Predicting Progression of Polycystic Kidney Disease by 99mTc-Dimercaptosuccinic Acid Renal Scintigraphy

Renal scintigraphy with 99Tc-dimercaptosuccinic acid (DMSA) was used to determine the prognosis of patients with adult polycystic kidney disease. In 40 patients, DMSA renal uptake rate, serum creatinine and blood urea nitrogen (BUN) were examined in different periods, at least twice a year. These parameters were plotted on semilogarithmic paper against the course of observation period (years or months in duration). As the impairment of renal function progresses, these parameters gradually worsen, DMSA renal uptake decreases and serum creatinine and BUN elevate linearly. In the terminal stage when hemodialysis is required, total DMSA uptake decreased to less than 1%, and this paralleled the levels of 100 mg/dl of BUN and 10 mg/dl of serum creatinine. Accordingly, when linear lines of parameters are extended to those levels obtained in hemodialysis patients, the years and months which coincide on the abscissa can be accounted for when initiation of the hemodialysis is taken into consideration. Analysis of this linear relation in individual patients allows for an estimate of the progression of this disease and may assist in the determination of the effects of conservative treatment. This method also indicates that the level of DMSA uptake at the initial diagnosis is a critical factor in assessing the prognosis of the patient.