We studied the influence of erythropoietin (EPO) treatment on hemoglobin Alc (HbAlc) levels under conditions which eliminate the effect of changes in the blood glucose concentration. HbAlc levels, blood glucose, hematocrit (Hct) and reticulocyte counts were serially measured every two weeks after starting or stopping EPOadministration in 15 non-diabetic hemodialysis patients. EPOtreatment significantly influenced HbAlc levels, and the more erythropoiesis fluctuated by changing the dose ofEPO, the more HbAlc levels changed, though there were no significant changes in blood glucose levels during the study period. The changes in HbAlc during the 2-week period correlated inversely with both the changes in Hct during the same 2 weeks and the reticulocyte counts at that time. Weconcluded that the change in Hct should be kept in mind when the HbAlc level is evaluated in EPO-treated patients and a formula should be proposed to correct HbAlc levels based on the change in Hct or the reticulocyte count. (Internal Medicine 37: 826-830, 1998)

The decline of residual renal function (RRF) in peritoneal dialysis (PD) patients was analysed and assessed, and risk factors affecting its decline were identified. Residual glomerular filtration rate (GFR) was calculated from averaging the urea and creatinine clearance by 24-h urine collection, and peritoneal solute removal was evaluated by creatinine clearance calculated from 24-h effluent collection. Both GFR and peritoneal solute removal were chronologically examined in 34 PD patients from the time of initiation, and risk factors associated with rapid GFR decline were investigated. The RRF contributed to 43.1 +/- 17.6% of total (peritoneal and renal) weekly creatinine clearance at 1 month after initiation of PD. Residual GFR, however, declined continuously with time (-0.19 +/- 0.14 mL/min per month), and the reduction rate was high with a higher GFR, higher normalized dietary protein intake, higher urine volume and higher urine protein excretion at the initiation of PD. Other factors related to the rapid decline of GFR were: being older than 60 years of age, automated peritoneal dialysis (APD) rather than continuous ambulatory peritoneal dialysis, mean blood pressure higher than 110 mmHg, and serum human atrial natriuretic peptide level higher being than 60 pg/dL. These data suggest that while RRF plays an important role in the removal of uraemic solute in PD patients, they show a significant decrease over 2 years. The factors related to the rapid decline of GFR corresponded to older age, modality of PD (APD), higher GFR and higher amount of urine protein at initiation, higher dietary protein intake, and inadequate control of hypertension and body fluid volume.

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Low-density lipoprotein apheresis retards the progression ofmove a large amount of plasma lipid directly from pahyperlipidemic overt diabetic nephropathy. tients in a short time. If hyperlipidemia played an impor-Background. Hyperlipidemia has recently received attentant role in the progression of renal diseases, it should tion as being involved in the progression of diabetic nephropabe possible to improve renal injury by LDL-A. Some thy (DN). Low-density lipoprotein apheresis (LDL-A) can resuccessful clinical results were already reported for primove a large amount of plasma lipid directly from the patients in a short time. mary nephrotic syndrome caused by focal glomeruloscle-Methods. Fifteen type 2 diabetic patients with overt nerosis [4, 5]. LDL-A, however, has not yet been used in phropathy received LDL-A in two different manners: shortpatients with DN. In this study, we performed LDL-A term intensive therapy (SIT) for nine patients and long-term in hyperlipidemic overt DN patients to evaluate the efintermittent therapy (LIT) for six patients.fect of this therapy on the progression of DN.Results. The changes in the monthly decline rates of reciprocal serum creatinine (1/Cr) were Ϫ0.035 Ϯ 0.020 in the threemonth period before SIT, 0.047 Ϯ 0.041 during and until two METHODS weeks after SIT, and Ϫ0.035 Ϯ 0.015 after a period of two weeks from the therapy. The mean duration of LIT in six Patients patients was 8.2 Ϯ 7.4 months, and the mean monthly decline Fifteen type 2 diabetic patients (nine males and six rates of 1/Cr significantly decreased during the period of LIT as compared with the six-month period before the treatment. females, mean age 60.3 Ϯ 6.4) with nephropathy were Conclusion. LDL-A can retard the progression of overt DN,