Most published reports indicate that intensified hemodialysis results in better pregnancy outcomes. Here we studied clinical characteristics and the outcomes of 28 pregnant women receiving hemodialysis. We found an association between maternal blood data and birth weight, and gestational age and outcomes. There were 18 surviving infants who were followed up for one year. In the others there were 4 spontaneous abortions, 1 stillbirth, 3 neonatal deaths and 2 deaths after birth. Analysis of blood chemistry for 20 pregnancies from 12 weeks of gestation until delivery showed that the average hemoglobin level was significantly higher in the group that successfully delivered than in the unsuccessful group. There were significant negative relationships between the blood urea nitrogen (BUN) level and the birth weight or gestational age in the latter cohort. A birth weight equal to or greater than 1500 g or a gestational age equal to or exceeding 32 weeks corresponded to BUN levels of 48-49 mg/dl or less. Whether the low BUN is the direct cause of the improved outcome remains to be examined.

The Committee of Scientific Academy of the Japanese Society for Dialysis Therapy (JSDT) proposes a new standard on microbiological management of fluids for hemodialysis and related therapies. This standard is within the scope of the International Organization for Standardization (ISO), which is currently under revision. This standard is to be applied to the central dialysis fluid delivery systems (CDDS), which are widely used in Japan. In this standard, microbiological qualities for dialysis water and dialysis fluids are clearly defined by endotoxin level and bacterial count. The qualities of dialysis fluids were classified into three levels: standard, ultrapure, and online prepared substitution fluid. In addition, the therapeutic application of each dialysis fluid is clarified. Since high-performance dialyzers are frequently used in Japan, the standard recommends that ultrapure dialysis fluid be used for all dialysis modalities at all dialysis facilities. It also recommends that the dialysis equipment safety management committee at each facility should validate the microbiological qualities of online prepared substitution fluid.

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Renal replacement therapy with dialyzers capable of enhanced internal filtration (IF) can be an alternative to standard hemodiafiltration, as it provides convective solute removal comparable to that of hemodiafiltration by a simple procedure. In this study, we clinically evaluated the effect of the hollow fiber length in the dialyzer, a crucial factor influencing the rate of IF, by comparing two commercial dialyzers (BS-1.6U, BS-1.6UL, Toray, Japan) which differed in the fiber length, but had the same surface area and inner diameter of their hollow fibers. We showed that in the dialyzer with the longer fibers, the pressure profile along the dialyzer was significantly altered, and the solute clearance tended to be increased. In addition, we successfully quantified the IF rate with a Doppler ultrasound in the experimental circuit, by measuring the blood flow velocities along the bundle of fibers. We showed that the changes in the blood flow velocity were more marked in the dialyzer with the longer fibers; the calculated IF rates in the dialyzers with the shorter and longer fibers were 11.1 mL/min and 37.7 mL/min, respectively, which seemed to be compatible with the solute clearances. This simple and readily applicable method is expected to be useful in the development of modified dialyzers to fully exploit the benefits of IF in renal replacement therapy.

ERI positively correlated with long-chain C18 acylcarnitine and negatively correlated with short-chain C5-OH acylcarnitine. C5-OH and C18 acylcarnitines at baseline might be contributing factors in distinguishing responders from nonresponders after L-carnitine administration.