Yoshihei Hirasawa

Hemodialysis-Associated Asthma in a Renal Failure Patient

In a renal failure patient, asthma developed after 1 year hemodialytic treatment. The attack was exclusively associated with each hemodialysis. Skin test to the usual allergen such as house dusts or pollens was negative. The provocation test by inhaling acetate solution or oral intake of acetic acid was positive resulting in an increase in the pulmonary resistance, or asthmatic attack. This asthma disappeared completely after substitution of acetate in the hemodialysis by the use of a bicarbonate dialysate. Acetate might therefore precipitate the attack of asthma.

Autonomic Nervous Dysfunction in Patients on Long-Term Hemodialysis

The level of plasma dopamine-beta-hydroxylase (DBH) activity in subjects at rest was found to be significantly lower in 12 patients on long-term hemodialysis than in a healthy 8-member control group: 28.3 +/- 7.2 and 13.6 +/- 7.6 IU/1, respectively (p less than 0.01). Following immersion of one hand of each subject into cold water (4 degrees C) for 1 min, a significant rise was observed in both groups, 6.1 +/- 4.8 IU/1 for the control and 1.6 +/- 1.4 IU/1 for the patient group (p less than 0.01). Upon tilting up the head of all subjects, activity in both groups increased significantly, but a markedly smaller rise was found in the patient group: 5.8 +/- 4.8 and 1.1 +/- 1.6 IU/1 for the two groups, respectively (p less than 0.01). The data suggest an autonomic nervous dysfunction in patients on long-term hemodialysis.

Hemodynamic effects of acetate in man.

To determine the action of acetate in man, 1.7mEq/ml of sodium acetate was infused in 10 patients on chronic hemodialysis. It was administered intravenously in 1.5mEq/min for 5 min followed by 3.8mEq/min for another 5 min. As control, 1.71mEq/ml of sodium chloride was infused in a similar manner. Following the infusion of sodium acetate, heart rate increased slightly but significantly (p less than 0.01). Limb blood flow measured in an upper limb by the venous occlusion method, showed an increase in all of them and it was significant( p less than 0.001). The peripheral vascular resistance (=mean arterial blood pressure/limb blood flow) showed a significant fall (p less than 0.001). The analysis of systolic time interval showed a change suggestive of depression of heart function at the end of sodium acetate infusion (p less than 0.05). Such a vasodilating effect or a change in heart function was not observed following sodium chloride infusion. A depressant action of acetate upon the cardiovascular system may be, therefore, concluded.

Effect of Acetate Upon Arterial Gases

Following infusion of sodium acetate, a significant fall in arterial oxygen tension (PO2) was observed (p less than 0.001). A rise in PCO2 or bicarbonate was also statistically significant. pH was however remained unchanged. Though a rise in PCO2, bicarbonate, pH was observed following infusion of sodium bicarbonate, no significant fall in PO2 was observed. These results suggest a role of acetate ion for the fall of arterial oxygen tension; the hemodialysis-induced hypoxemia.

Diminished Vascular Reactivity to a Cold Stress in Azotemic Patients

The integrity of the neurovascular reflex arc to a cold stimulus was evaluated by the determination of the response of the limb blood flow in fifteen azotemic patients. Seven of these patients became hypotensive during the course of renal failure despite comparable hemodialysis therapy. They showed a constant low blood pressure (mean blood pressure below 90 mmHg). The reactivity index (defined as the relative change at the 15th second of stimulus) was 15.9 +/- 14.4% for these hypotensive patients, and 35.7 +/- 12.0% for the remaining eight normotensive ones, while that of healthy subjects was 48.7 +/- 8.7%. The greatly diminished reactivity of the hypotensive patients could not be explained by humoral or hormonal factors. The dysfunction of somatic nerves of the vascular geometry could not be responsible for the difference. A dysfunction of adrenergic control of blood pressure was, therefore, strongly suggested.

Vascular responsiveness and body fluid status in patients on chronic hemodialysis.

The vascular responsiveness and the body fluid distribution were studied in 5 hypotensive and 11 normotensive patients on long-term hemodialysis. A diminished vascular responsiveness to intravenously infused norepinephrine or angiotensin II was found in uremic patients, especially in the hypotensive group. A slightly larger, but non-significant circulating blood volume (CBV) and a less extracellular fluid volume (ECF) was found in the hypotensive group as compared with those of the normotensive group. These results suggest that with autonomic nervous dysfunction, such a diminution of vascular responsiveness may be an another factor responsible for the development of hypotension.

Fluid Kinetics During Hemodialysis

The reflection coefficient of urea was estimated in the present paper since some clinical experiences suggest an importance of urea dependent osmolality for the circulatory stability. In the physiology, the reflection coefficient of urea is usually regarded to be negligibly small though it varies from one organ to another. The value obtained in the present paper is large and urea was supposed osmotically to be active affecting the fluid movement across the capillary wall. A fall of urea concentration during hemodialysis may aggravate potentially the decrease of circulating blood volume.

Bone histomorphometry in chronic renal failure

Thirty uremic patients were classified to 5 subgroups according to histological criteria as osteitis fibrosa (OF), mixed OF plus osteomalacia (OM), mild hyperparathyroidism, aplastic bone disease and OM. Serum level of PTH was elevated in OF while it was lowered in aplastic bone disease. Serum level of PTH and ALP well correlated with bone formation parameters of histomorphometry suggesting that these parameters could predict turnover of bone in uremic patients. Serum level of aluminum was correlated with the duration of hemodialysis and aluminum positive bone surface. This might correspond to the aluminum hydroxide consumption. No double tetracycline uptake was observed in the diabetic patients and their serum PTH level was considerably low, suggesting that lowered PTH might be partly responsible for the low bone turnover status.

Prevention of hepatitis B by immunoglobulin contained high titer antiHBs antibody HBIG

HBIG was adminis tered to medical staff exposed HBV by accidental needle stick. One h u n d r e d twenty cases were adminis te red HBIG, consisting of 72 cases of nurses, 40 cases of doctors, 4 cases of technicians and others. HBsAg or anti-HBs positive cases were excluded f rom the study, and did not receive HBIG. All cases were followed for six months and examined GOT, GPT, HBsAg and ant i -HBs twice a month . Most of ant i -HBs titers of HBIG used were 25,600-32,000 folds in PHA. Serum ant i -HBs ti ter after HBIG inject ion was mostly kept at 25 in PHA for six weeks. Dur ing 6 months of follow-up period, no cases developed hepat i t is B, bu t 2 cases cont rac ted the disease seven and ten m o n t h after the injection. It is not clear whe ther these cases were infected with the needle stick despite HBIG or infected later after the d isappearance of anti-HBs. From these results, it seemed tha t HBIG was effective for the prevent ion of HBV infection dur ing 2-3 months after the injection. No side effect of HBIG was observed.