Biocompatibility of hemodialysis (HD) systems have been considerably improved. However, mortality and morbidity rates of patients have remained high, raising questions regarding the biocompatibility of current systems. In the present study, 70 patients on regular HD (51 males; mean age, 63 years; median duration of HD, 18 months) with high-performance membrane (polysulfone, 77%; polymethylmethacrylate, 23%) at Tohoku University Hospital were examined. Blood samples before and after HD, were subjected to measure apoptosis cells of white blood cells, plasma levels of the following molecules: myeloperoxidase (MPO), pentraxin 3 (PTX3), angiogenin, complements, and 17 cytokines. The main findings were as follows: significant decreases in leukocyte counts by dialysis, significant increases in apoptosis-positive leukocytes by dialysis (neutrophils and monocytes), and significant decrease in plasma angiogenin accompanying increase in plasma MPO and PTX3 levels, with no or only marginal changes in plasma pro-inflammatory cytokine levels and complement products by dialysis. The findings underlined the unsolved issue of bio-incompatibility of HD systems, and suggest the possible pathology of neutrophil apoptosis accompanying MPO release for the development of microinflammation in patients on HD.

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Background: A spontaneous iliopsoas muscle hematoma is relatively rare and often associated with abnormal coagulation. Nafamostat mesilate is an anticoagulant agent that is sometimes used to treat hemodialysis patients at high risk of bleeding. Although severe drug allergy caused by nafamostat mesilate was previously reported, spontaneous iliopsoas muscle hematoma secondary to disseminated intravascular coagulation caused by nafamostat mesilate allergy has not yet been reported. Case presentation: Severe nafamostat mesilate allergy occurred in a 78-year-old male patient with a 2-year history of hemodialysis. During hospitalization, disseminated intravascular coagulation occurred followed by a progressive iliopsoas muscle hematoma a few days later. Emergent transarterial lumbar artery embolization was successfully performed. Conclusion: For dialysis patients, a detailed medical history including repeated nafamostat mesilate use and considering an allergy to nafamostat mesilate in differential diagnosis are critical. In addition to early diagnosis, when an iliopsoas hematoma occurs, early intravascular treatment is important.

Background and Aims Owing to the quality developments of membrane material and dislysis water, it is believed that the biocompatibility of haemodialysis (HD) system has been considerably improved. However, mortality and morbidities of dialysis patients have remained unacceptably high, which raises a question as to the biocompatibility improvement of current HD systems. Method Seventy-one patients on regular HD (male/female: 52/19, mean age: 63 years old, median HD duration: 19 months, HD session 3 times a week for 3 to 4 hours each by using high performance synthetic membrane) at Tohoku University Hospital were examined. Blood samples were obtained from all patients before and after the HD session, to measure followings; number of white blood cell fraction, and apotosis cells, plasma levels of following molecules; myeloperoxidase (MPO), pentraxin 3, angiogenin, lactoferrin, complement (C3a, C5a, C5b-9), and 17 cytokines. Apoptosis (positive for Annexin-V-FITC and negative for propidium iodide) was measured in 100,000 cells by flow cytometer, and plasma molecules were measured by ELISA kit. Results The main findings of this study were as follows (changes in the values after HD as compared to the pre HD); the significant decrease of leukocytes counts (neutrophil and lymphocyte), significant increases of apoptosis positive cells of leukocytes (neutrophiles and monocytes), significant increases of plasma MPO and pentraxin3 levels, significant decrease of angiogenin, and, no or only marginal changes in plasma pro-inflammatory cytokine levels and complement products. There was a significant positive correlation between the change in MPO and apoptosis before and after HD. Conclusion Bio-incompatibility of HD has remained a crucial issue even in the current systems. Among the several pathologies, process of neutrophile apoptosis accompanying MPO degranulation, may plays a central role for developing microinflammation. In this regard, change of plasma MPO could be a clinical marker for the biocompatibility of HD system. And in order to achieve better patients’ outcomes, innovative HD systems which fully improve biocompatibility are needed.