Tetsuo Miyazaki

Elevation of Interleukin 6 in the Dialysate Reflects Peritoneal Stimuli and Deterioration of Peritoneal Function

Akira Fujimori, MD, Artificial Kidney Department, Konan Hospital, 1-5-16, Kamokogahara, Higashinada-ku, Kobe 658 (Japan) Dear Sir, Deterioration of peritoneal function, in which inadequate ultrafiltration is usually present, is a serious complication of long-term CAPD patients. At present, however, no simple means to evaluate peritoneal function have been established. Interleukin 6 (IL-6) is secreted in vitro by peritoneal mesothe-lial cells [1], and a very high EL-6 concentration in the CAPD effluent was associated with increased permeability of the peritoneum [2]. Therefore, we measured dialysate IL-6 and discussed the relationship between IL-6 and peritoneal function. Peritoneal function was evaluated by peritoneal function index (PFI), which was the ratio of ultrafiltration volume (ml) to dialysate osmotic pressure (mosm) [3]. As shown in figure 1, a negative correlation between PFI and dialysate IL·6 concentration was observed. Then, we examined the effects of dialysate glucose on effluent IL·6, since high concentrations of the dialysate glucose appear to be one of the causative factors of deterioration of peritoneal function. As shown in figure 2, dialysate glucose dosedependently increased IL·6 concentration. Although it is not known whether IL-6 is secreted by peritoneal mesothelial cells or other cell types such as fibroblasts, T cells, or endothelial cells, IL-6 could be a marker for peritoneal function and possibly histological injuries of the peritoneum. Many of the longterm CAPD patients have problems of inadequate ultrafiltration. They might drop out of the CAPD treatment or would be treated under hemodialysis until peritoneal function recovered. Therefore, measurement of effluent IL-6 might help to decide whether or not CAPD should be interrupted or discontinued. In addition, effluent IL-6 might also indicate the appropriate time to resume CAPD treatment.

Measurement of Cortical Bone Density in the Radius by Peripheral Quantitative Computed Tomography in Hemodialysis Patients

Akira Fujimori, MD, Department of Artificial Kidney, Konan Hospital, 1-5-16 Kamokogahara, Higashinada-ku, Kobe 658 (Japan) Dear Sir, In the uremic patients who develop secondary hyperparathyroidism, bone loss in the cortex would be more remarkable than in the trabecular bone, which may increase in some patients [1]. Since bone mineral density (BMD) of the lumbar spine determined by dual-energy X-ray absorptiometry does not help us evaluate the severity of the renal osteodystrophy, we used peripheral quantitative computed tomography (pQCT), which can separately determine cortical BMD and trabecular BMD of the radius, to examine the clinical importance of the measurement of the cortical BMD in hemodialysis patients. Measurement of BMD was performed as reported before [2], The device used was XCT-960 (Stratec-Norland, Germany and USA). Trabecular BMD was measured at the ultradistal site of the radius (at 4% of the length of the bone from the distal end). A more proximal site at 15% with abundant cortical bone was selected to measure cortical BMD. After a transsectional slice of the radius with 2.5 mm thickness had been obtained, 55% of the total bone area was removed from the periosteal surface, to peel

Clinical experience with the Valli catheter

従来使用されてきたCAPD用カテーテルは, 腹腔内位置移動や被包化現象のため, 排液障害がしばしば発生し治療には難渋する. 今回我々は主にこの排液障害を防止する目的で開発されたValli catheter (Valli cath.) を, 慢性腎不全症例5例に臨床使用し, 検討を加えた.使用したValli cath.の形状は, 腹腔外部はTenckhoff double cuff catheter (Tenckhoff d. c. cath.) と同様であるが, 腹腔内部はカテーテル先端を3.5×8cmの楕円形バルーンで覆い, 腹腔内臓器より隔絶している.カテーテル留置法は, 全症例とも観血的開腹術 (腰椎麻酔下4例, 局所麻酔下1例) で挿入した. 観察期間は最長15ヵ月, 最短2ヵ月 (総53 patient-months), 平均10.6 patient-monthsで, 現在全例ともCAPD療法継続中である. この期間中, 全症例ともバルーンの形状は良好に保たれ, ダグラス窩に固定され, 注排液障害もなく, また注排液速度もTenckhoff cathと比較すると早い結果を得た.出口部感染, トンネル感染, カフ感染等はこの期間中発生しなかった. しかし, Valli cathの腹腔外部形状はTenckhoff d. c. cathと同一であることより, これらの合併症は同頻度で発生する可能性があり, さらに材質, 形状等につき研究開発される必要がある.