The Impact of Tunneled Central Venous Hemodialysis Catheter on Mortality of Elderly Hemodialysis Patients Hospitalized in a Long-Term Care Hospital.

INTRODUCTION: The association between tunneled central venous hemodialysis catheters (TCVCs) and mortality in hospitalized elderly hemodialysis (HD) patients remains unclear. METHODS: This retrospective observational study was conducted in a long-term care hospital. We evaluated the association between TCVC and mortality in HD patients hospitalized between 2015 and 2020. RESULTS: A total of 463 patients were compared: TCVC group (n = 53) and non-TCVC group (n = 410) including arteriovenous fistula (AVF, n = 369), arteriovenous graft (AVG, n = 30), and superficialized brachial artery (SBA, n = 11). The mean ages were 80 and 78 years in the TCVC and non-TCVC groups, respectively. Overall mortality rates for all-cause and cardiovascular diseases (CVDs) were higher in the TCVC group than in the non-TCVC group (log-rank, p = 0.01, and p = 0.009). Overall mortality was higher in the TCVC group than in the AVF group (p = 0.04), but there were no significant differences between the TCVC, AVG, and SBA groups. In Cox proportional hazards regression models, age, dialysis vintage, male sex, Charlson Comorbidity Index (CCI), and serum albumin level were associated with all-cause, CVD, and infectious disease (ID) mortalities, but TCVC was not associated with all-cause (hazard ratio, 1.31; 95% confidence interval, 0.95-1.80; p = 0.1), CVD (1.54; 0.99-2.39; p = 0.051), and ID (0.91; 0.48-1.70; p = 0.8) mortalities. Among patients aged ≥80 years, with dialysis vintage ≥7 years and CCI ≥10, the overall mortality rates were comparable between the two groups. CONCLUSIONS: Among elderly HD patients in the long-term care hospital, TCVC was not associated with mortality.

The international glycan repository GlyTouCan version 3.0.

Glycans serve important roles in signaling events and cell-cell communication, and they are recognized by lectins, viruses and bacteria, playing a variety of roles in many biological processes. However, there was no system to organize the plethora of glycan-related data in the literature. Thus GlyTouCan (https://glytoucan.org) was developed as the international glycan repository, allowing researchers to assign accession numbers to glycans. This also aided in the integration of glycan data across various databases. GlyTouCan assigns accession numbers to glycans which are defined as sets of monosaccharides, which may or may not be characterized with linkage information. GlyTouCan was developed to be able to recognize any level of ambiguity in glycans and uniquely assign accession numbers to each of them, regardless of the input text format. In this manuscript, we describe the latest update to GlyTouCan in version 3.0, its usage, and plans for future development.

Association between Dialysis Modality and Infectious Diseases: Peritoneal Dialysis versus Hemodialysis.

INTRODUCTION: For dialysis patients with end-stage kidney disease, infectious diseases (IDs) are the most common causes of hospitalization and death. However, the association between dialysis modality and IDs remains unclear. We aimed to determine the association between the dialysis modality and IDs. METHODS: This retrospective observational cohort study compared the emergency hospitalization and mortality for IDs between peritoneal dialysis (PD) and hemodialysis (HD) patients. After propensity score matching, the risk factors were evaluated by the Cox proportional hazard regression models. RESULTS: A total of 260 patients were compared - 130 of 135 PD and 130 of 706 HD patients. When the modality-specific ID (PD-catheter ID/peritonitis- and vascular access-related ID) was excluded, no significant differences in emergency hospitalization and mortality rates for overall IDs were observed between the PD and HD groups. Serum ferritin (HR, 2.17; CI, 1.06-4.43; p = 0.03) and Charlson Comorbidity Index (CCI) (HR, 1.24; CI, 1.01-1.52; p = 0.04) were significant predictors of emergency hospitalization for IDs, whereas age (HR, 1.12; CI, 1.05-1.19; p < 0.001), male (HR, 3.38; CI, 1.01-11.3; p = 0.048), serum alkaline phosphatase (ALP) (HR, 6.87; CI, 2.18-21.7; p = 0.001), C-reactive protein (CRP) (HR, 10.7; CI, 3.55-32.1; p < 0.001), and CCI (HR, 1.79; CI, 1.27-2.52; p < 0.001) were significant predictors of ID mortality. When modality-specific ID was included, the emergency hospitalization rate for overall IDs was higher in the PD groups, and PD was a significant predictor of emergency hospitalization for IDs, whereas no significant difference in mortality rate for overall IDs was found between the PD and HD groups. CONCLUSIONS: ID events were not associated with dialysis modality when modality-specific ID was excluded, whereas the risk of modality-specific IDs was higher in PD than HD. Serum ferritin and ALP as well as age, male sex, CRP, and CCI were the risk factors for ID events.

SugarDrawer: A Web-Based Database Search Tool with Editing Glycan Structures.

In life science fields, database integration is progressing and contributing to collaboration between different research fields, including the glycosciences. The integration of glycan databases has greatly progressed collaboration worldwide with the development of the international glycan structure repository, GlyTouCan. This trend has increased the need for a tool by which researchers in various fields can easily search glycan structures from integrated databases. We have developed a web-based glycan structure search tool, SugarDrawer, which supports the depiction of glycans including ambiguity, such as glycan fragments which contain underdetermined linkages, and a database search for glycans drawn on the canvas. This tool provides an easy editing feature for various glycan structures in just a few steps using template structures and pop-up windows which allow users to select specific information for each structure element. This tool has a unique feature for selecting possible attachment sites, which is defined in the Symbol Nomenclature for Glycans (SNFG). In addition, this tool can input and output glycans in WURCS and GlycoCT formats, which are the most commonly-used text formats for glycan structures.

GlycanFormatConverter: a conversion tool for translating the complexities of glycans.

MOTIVATION: Glycans are biomolecules that take an important role in the biological processes of living organisms. They form diverse, complicated structures such as branched and cyclic forms. Web3 Unique Representation of Carbohydrate Structures (WURCS) was proposed as a new linear notation for uniquely representing glycans during the GlyTouCan project. WURCS defines rules for complex glycan structures that other text formats did not support, and so it is possible to represent a wide variety glycans. However, WURCS uses a complicated nomenclature, so it is not human-readable. Therefore, we aimed to support the interpretation of WURCS by converting WURCS to the most basic and widely used format IUPAC. RESULTS: In this study, we developed GlycanFormatConverter and succeeded in converting WURCS to the three kinds of IUPAC formats (IUPAC-Extended, IUPAC-Condensed and IUPAC-Short). Furthermore, we have implemented functionality to import IUPAC-Extended, KEGG Chemical Function (KCF) and LinearCode formats and to export WURCS. We have thoroughly tested our GlycanFormatConverter and were able to show that it was possible to convert all the glycans registered in the GlyTouCan repository, with exceptions owing only to the limitations of the original format. The source code for this conversion tool has been released as an open source tool. AVAILABILITY AND IMPLEMENTATION: https://github.com/glycoinfo/GlycanFormatConverter.git. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Association between Dialysis Modality and Cardiovascular Diseases: A Comparison between Peritoneal Dialysis and Hemodialysis.

INTRODUCTION: In patients with end-stage kidney disease (ESKD), cardiovascular diseases (CVDs) are the most common causes of hospitalization and death. OBJECTIVE: We aimed to determine the association between dialysis modality and CVDs. METHODS: This retrospective observational cohort study compared the emergency hospitalization and mortality of patients with CVDs who underwent peritoneal dialysis (PD) versus hemodialysis (HD). After propensity score matching, the risk factors were evaluated using Cox proportional hazards regression models. RESULTS: A total of 260 patients were matched: 130 of 135 PD (75 men; age, 65.4 years; dialysis vintage, 3.3 years) and 130 of 706 HD (70 men [p = 0.5]; 66.6 years [p = 0.4]; dialysis vintage, 3.1 years [p = 0.5]) patients. Emergency hospitalization rates (hospitalizations/person-years) for overall CVDs (0.138 vs. 0.066, p = 0.002) and pulmonary edema (0.048 vs. 0.019, p = 0.03) were significantly higher in patients who underwent PD than those who underwent HD. The log-rank test revealed that all-cause and CVD mortalities were significantly higher in PD (both p < 0.001). Mortality rates (deaths/person-years) for overall CVDs (0.058 vs. 0.015, p < 0.002), cerebrovascular disease (0.019 vs. 0.004, p = 0.03), and ischemic heart disease (0.010 vs. 0, p = 0.02) were significantly higher in PD. The Cox proportional hazards regression model showed that PD and age were significant predictors of emergency hospitalization (hazard ratio [HR] 2.70; 95% CI 1.53-4.77; p = 0.001) and mortality (HR 4.41; 95% CI 1.66-11.72; p = 0.003) for CVDs. CONCLUSIONS: PD is a risk factor for emergency hospitalization and mortality associated with CVDs in dialysis patients with ESKD. Strict control of body fluid balance may prevent cardiovascular events in patients undergoing PD.

Increased Frequency of In-Center Hemodialysis as Rescue Therapy: Impact on Hospitalization for Acute Cardiovascular Events.

BACKGROUND: The intermittency of conventional hemodialysis (HD) leads to an increase in cardiovascular events. OBJECTIVE: We aimed to evaluate the effect of in-center frequent HD (FHD, 4-6 times a week) as a rescue option for cardiovascular events. METHOD: Patients who failed to achieve fluid volume control with conventional HD (thrice a week) were administered FHD. A total of 52 patients were divided into 2 groups by left ventricular ejection fraction (LVEF): low ejection fraction (LEF [n = 26], LVEF < 55%) and normal ejection fraction (NEF [n = 26], LVEF ≥55%). Mortality and hospitalization rates were evaluated. RESULTS: All-cause mortality tended to be higher in the LEF than in the NEF group (p = 0.09). The 1-year hospitalization rate for acute cardiovascular events decreased in both LEF (1.24-0.89; p = 0.049) and NEF (0.36-0.16; p = 0.01) groups. In Cox regression models, LVEF < 55% (hazard ratio 3.81; 95% CI 1.15-12.66; p = 0.03) was identified as the risk factor for hospitalization for acute cardiovascular events. CONCLUSION: In-center FHD may decrease acute cardiovascular events.

Impact of Hybrid Therapy Comprising Peritoneal Dialysis and Hemodialysis on Acute Cardiovascular Events.

BACKGROUND: The impact of hybrid therapy comprising peritoneal dialysis (PD) and hemodialysis on cardiovascular events in PD patients remains unclear. OBJECTIVE: We aimed to evaluate the effect of hybrid therapy on cardiovascular events. METHODS: A total of 93 PD patients undergoing hybrid therapy for ≥3 years were divided into 2 groups according to left ventricular ejection fraction (LVEF): lower ejection fraction (LEF [n = 29], LVEF < 60%) and normal ejection fraction (NEF [n = 64], LVEF ≥60%). Hospitalization rates and echocardiographic parameters were evaluated. RESULTS: The 1-year hospitalization rate for acute cardiovascular events decreased after the therapy initiation in both groups (LEF: 0.36-0.11, p = 0.02 and NEF: 0.43-0.06, p < 0.001). In generalized linear mixed models, LVEF (44 ± 15%) improved at 1, 2, and 3 years after initiation (53 ± 18, 55 ± 17, and 58 ± 7%; p < 0.05) in the LEF group, whereas, in the NEF group, LVEF (68 ± 5%) was maintained at 1, 2, and 3 years after initiation (67 ± 8, 67 ± 9, and 68 ± 9%; p > 0.05). Mitral inflow E velocity to tissue Doppler e' ratio was maintained at the same level at 1-3 years after initiation in both groups. Left ventricular mass index (LVMI; 189 ± 41 g/m2) was decreased at 1 (178 ± 35 g/m2; p = 0.8), 2 (160 ± 45 g/m2; p = 0.008), and 3 (166 ± 47 g/m2; p = 0.05) years after initiation in the LEF group, whereas in the NEF group, LVMI (157 ± 45 g/m2) was maintained at 1, 2, and 3 years after initiation (153 ± 40, 155 ± 54, and 158 ± 52 g/m2; p > 0.05). CONCLUSION: Hybrid therapy decreased acute cardiovascular events and improved systolic cardiac function in PD patients in the LEF group.

GlyTouCan 1.0--The international glycan structure repository.

Glycans are known as the third major class of biopolymers, next to DNA and proteins. They cover the surfaces of many cells, serving as the 'face' of cells, whereby other biomolecules and viruses interact. The structure of glycans, however, differs greatly from DNA and proteins in that they are branched, as opposed to linear sequences of amino acids or nucleotides. Therefore, the storage of glycan information in databases, let alone their curation, has been a difficult problem. This has caused many duplicated efforts when integration is attempted between different databases, making an international repository for glycan structures, where unique accession numbers are assigned to every identified glycan structure, necessary. As such, an international team of developers and glycobiologists have collaborated to develop this repository, called GlyTouCan and is available at http://glytoucan.org/, to provide a centralized resource for depositing glycan structures, compositions and topologies, and to retrieve accession numbers for each of these registered entries. This will thus enable researchers to reference glycan structures simply by accession number, as opposed to by chemical structure, which has been a burden to integrate glycomics databases in the past.

GlyTouCan: an accessible glycan structure repository.

Rapid and continued growth in the generation of glycomic data has revealed the need for enhanced development of basic infrastructure for presenting and interpreting these datasets in a manner that engages the broader biomedical research community. Early in their growth, the genomic and proteomic fields implemented mechanisms for assigning unique gene and protein identifiers that were essential for organizing data presentation and for enhancing bioinformatic approaches to extracting knowledge. Similar unique identifiers are currently absent from glycomic data. In order to facilitate continued growth and expanded accessibility of glycomic data, the authors strongly encourage the glycomics community to coordinate the submission of their glycan structures to the GlyTouCan Repository and to make use of GlyTouCan identifiers in their communications and publications. The authors also deeply encourage journals to recommend a submission workflow in which submitted publications utilize GlyTouCan identifiers as a standard reference for explicitly describing glycan structures cited in manuscripts.

WURCS: the Web3 unique representation of carbohydrate structures.

In recent years, the Semantic Web has become the focus of life science database development as a means to link life science data in an effective and efficient manner. In order for carbohydrate data to be applied to this new technology, there are two requirements for carbohydrate data representations: (1) a linear notation which can be used as a URI (Uniform Resource Identifier) if needed and (2) a unique notation such that any published glycan structure can be represented distinctively. This latter requirement includes the possible representation of nonstandard monosaccharide units as a part of the glycan structure, as well as compositions, repeating units, and ambiguous structures where linkages/linkage positions are unidentified. Therefore, we have developed the Web3 Unique Representation of Carbohydrate Structures (WURCS) as a new linear notation for representing carbohydrates for the Semantic Web.

Hospitalizations for non-SARS-CoV-2 respiratory infectious diseases among patients on hemodialysis: A comparison before and during the coronavirus disease 2019 pandemic.

INTRODUCTION: The impact of coronavirus disease 2019 (COVID-19) infection control on other infections in patients with dialysis has not received sufficient consideration. METHODS: We compared hospitalization and mortality rates among patients who underwent hemodialysis (HD) at three dialysis centers before (March 2018-February 2020) and during (March 2020-February 2022) the COVID-19 pandemic. RESULTS: This study included 1696 patients undergoing HD (mean age, 70 years; 1099 men). Compared to before the COVID-19 pandemic, the emergency hospitalization rate (per 100 dialysis patient-years) for non-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) respiratory infectious diseases (IDs) (7.0 vs. 4.1, p < 0.001) significantly decreased during the COVID-19 pandemic, whereas the hospitalization rates for other IDs were comparable. The mortality rates for non-SARS-CoV-2 respiratory IDs were comparable before and during the COVID-19 pandemic. CONCLUSIONS: Hospitalizations for non-SARS-CoV-2 respiratory IDs among patients undergoing HD may have decreased owing to the implementation of infection control measures for COVID-19.

Efficacy of drug-coated balloon catheters for patients with short-term recurrent dysfunction of arteriovenous fistula.

BACKGROUND: In this study, we aimed at clarifying the usefulness of drug-coated balloon catheters (DCBs) for arteriovenous fistulas (AVFs) that repeatedly undergo restenosis over a short period and to examine the factors that influence the patency period after DCB use. METHODS: This retrospective observational study was conducted using IN.PACT AV in 29 cases of AVFs with repeated restenosis within approximately 3 months, and temporary patency before and after DCB use in the same patients was compared. For target participants, the flow volume, resistive index (RI), and vascular diameter of the brachial artery were measured using an ultrasound diagnostic device. Stenosis diameter, reference vessel diameter, and stenosis length of the lesion were measured before and after DCB dilatation using digital subtraction angiography. RESULTS: Before DCB angioplasty, the postintervention primary patency at 3 months was 66%, and the average interval was 92 ± 21 days (mean ± standard deviation). After DCB angioplasty, the postintervention primary patency rates at 3 and 6 months were 92% and 36%, respectively. The postintervention primary patency was significantly higher after than before DCB angioplasty (p < 0.0001). A sub-analysis was performed on 25 patients who were followed up for 4 months or more after DCB. The RI values before and after dilatation with DCB significantly differed between the patency group 4 or more months after DCB and the patency group less than 4 months after DCB. CONCLUSION: For AVFs that require frequent PTA over a short period of time, DCB improved the patency rate 3 months after PTA, but the improvement effect at 6 months was limited. The effect of DCB on prolonging the patency rate of AVFs that require frequent PTA over a short period of time may be correlated with the RI value before and after PTA.

Iatrogenic arteriovenous fistula in the brachial artery after percutaneous coronary intervention in a patient with end stage kidney disease.

Iatrogenic arteriovenous fistula (AVF) is a complication accompanying venous and arterial puncture. Herein we report a case of ligation closure of an iatrogenic AVF in the brachial artery after percutaneous coronary intervention (PCI) for the patient with end-stage kidney disease (ESKD). A 68-year-old woman presented with a history of several coronary angiographies (CAG) and PCI through the right brachial artery. After PCI, the patient experienced a thrill in the right elbow. Two years later, the patient initiated hemodialysis (HD) using a temporary HD catheter for ESKD and congestive cardiac failure. Ultrasonography and computed tomographic angiography revealed an iatrogenic AVF between the right brachial artery and the medial brachial vein. Blood flow in the brachial artery was 760 mL/min. However, the iatrogenic AVF was unusable as vascular access for HD, and prior ligation closure of the iatrogenic AVF was performed, considering the risk of cardiac failure due to double AVFs after the creation of a new AVF for HD. Subsequently, a new radial-cephalic AVF was created in the left forearm. Therefore, clinicians should consider the possibility of iatrogenic AVF in patients with ESKD having a history of CAG or PCI.

The predictive markers of severity and mortality in hospitalized hemodialysis patients with COVID-19 during Omicron epidemic.

INTRODUCTION: Predictive markers and prognosis remain unclear in hospitalized hemodialysis (HD) patients with coronavirus disease 2019 (COVID-19) during the Omicron epidemic. METHODS: We evaluated characteristics, laboratory parameters, and outcomes in hospitalized HD patients with COVID-19 (n = 102) at two centers between January and April 2022. RESULTS: The 30-day mortality rate was higher in moderate-critical group (n = 43) than mild group (n = 59) (16.3% vs. 1.7%; p = 0.007), and higher in patients with lower CC chemokine ligand 17 (CCL17) levels (<95.0 pg/mL) compared with normal CCL17 levels (19.0% versus 4.9%; p = 0.03). In multivariate analyses, a low CCL17 level (p = 0.003) was associated with moderate-critical conditions, and moderate-critical conditions (p = 0.04) were associated with 30-day mortality, whereas CCL17 was not associated with 30-day mortality. CONCLUSIONS: COVID-19 remains a fatal complication, and CCL17 was a predictive marker of severity in hospitalized HD patients during the Omicron epidemic.

COVID-19-associated pulmonary aspergillosis in hemodialysis patients.

Background: Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a fatal complication in the general population. However, there are few reports on CAPA in patients undergoing hemodialysis (HD). Methods: This retrospective observational cohort study was conducted at a single center between December 2020 and June 2021. We enrolled 21 HD patients with COVID-19 undergoing treatment and divided them into two groups, CAPA and non-CAPA (COVID-19 with and without pulmonary aspergillosis), and evaluated their characteristics, clinical outcomes and comorbidities. Results: The log-rank test revealed that the 90-day survival rate after the initiation of treatment for COVID-19 was significantly lower in the CAPA (n = 6) than in the non-CAPA group (n = 15) (P = 0.0002), and the 90-day mortality rates were 66.6% and 0% in the CAPA and non-CAPA groups, respectively. In the CAPA group, four patients died due to respiratory failure (on Days 6 and 20), gastrointestinal bleeding (Day 8) and sepsis (Day 33); the reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remained positive when they died. The remaining two patients survived and the negative conversion of RT-PCR for SARS-CoV-2 was confirmed on Days 10 and 15. The negative conversion of serum (1, 3)-ß-d-glucan (BDG) was confirmed on Day 15 in one patient; the BDG remained positive on Day 64 in the other. Conclusions: CAPA is a fatal complication in HD patients and the general population. Therefore, clinicians should consider the possibility of testing for CAPA in patients undergoing HD. Mycological workups may be helpful for the early detection of CAPA.

Seventeen years' experience of surgical options for encapsulating peritoneal sclerosis.

Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis (PD). The mortality rate for EPS has been high, primarily because of complications related to bowel obstruction. However recent advances in clinical research have established the pathogenesis and course of the condition and a treatment strategy. The final therapeutic option for EPS is surgical enterolysis, and we have performed 239 surgical procedures in 181 patients and observed favorable outcomes. Of 181 patients opting for surgery 64 (35.40%) died. Death was related to EPS in 33 patients (18.2%), including 14 who died postoperatively. The overall survival rate at 1, 2, 3, 5, and 8 years after diagnosis was 93%, 83%, 78%, 71%, and 60% respectively. The survival rate for EPS-related death at 1, 2, 3, 5, and 8 years after diagnosis was 95%, 90%, 87%, 81%, and 74% respectively. Median survival after diagnosis, considering death from any cause and death from EPS, was 43.9 months and 35.7 months respectively. In conclusion, we present favorable outcomes with EPS surgery in 181 patients encountered over a period of 17years. These data reconfirm that surgical treatment is essential for EPS patients. Encapsulating peritoneal sclerosis may no longer be a fatal complication and can be improved with accurate diagnosis and treatment.

Enhanced validation of small-molecule ligands and carbohydrates in the Protein Data Bank.

The Worldwide Protein Data Bank (wwPDB) has provided validation reports based on recommendations from community Validation Task Forces for structures in the PDB since 2013. To further enhance validation of small molecules as recommended from the 2016 Ligand Validation Workshop, wwPDB, Global Phasing Ltd., and the Noguchi Institute, recently formed a public/private partnership to incorporate some of their software tools into the wwPDB validation package. Augmented wwPDB validation report features include: two-dimensional (2D) diagrams of small-molecule ligands and carbohydrates, highlighting geometric validation outcomes; 2D topological diagrams of oligosaccharides present in branched entities generated using 2D Symbol Nomenclature for Glycan representation; and views of 3D electron density maps for ligands and carbohydrates, illustrating the goodness-of-fit between the atomic structure and experimental data (X-ray crystallographic structures only). These improvements will impact confidence in ligand conformation and ligand-macromolecular interactions that will aid in understanding biochemical function and contribute to small-molecule drug discovery.

Peritoneal dialysis patients with high effluent fibrin degradation products.

Encapsulating peritoneal sclerosis (EPS) is a major and fatal complication of peritoneal dialysis (PD). For treatment, the efficacies of steroids, tamoxifen, immunosuppressants, and surgical total intestinal enterolysis have been reported, but the results have not been sufficient. Because treatment after the onset of EPS is limited, a prophylactic therapy is needed. We previously reported that the level of effluent fibrin degradation products (eFDPs) is predictive of EPS. In the present study, we investigated the clinical course of PD cases with high eFDP levels, and the effect of prophylactic steroid therapy against EPS. Between January 2002 and August 2008, we investigated 310 PD patients, of whom 22 had an eFDP level of 30 microg/mL or more in 4-hour effluent from a fast peritoneal equilibration test (PET). Mean patient age was 62.6 +/- 11.1 years, and mean duration of dialysis was 42.7 +/- 45.5 months (range: 1 - 202 months). During a fast PET performed every 6 months, we measured, in 4-hour effluent, eFDPs, cancer antigen 125 (eCA125), and dialysate-to-plasma creatinine (D/P Cr). In addition, we calculated D/P beta2-microglobulin (beta2MG) from levels in overnight dialysis effluent and blood. In the 22 cases, the mean eFDP level was 66.6 +/- 39.2 microg/mL; the D/P Cr 0.78 +/- 0.1; and the D/P beta2MG 0.45 +/- 0.2. Steroid (5 - 30 mg daily) was administered to 8 of the 22 patients. In the 8 treated cases, the eFDP level, the D/P Cr, and the D/P beta2MG declined, but did not return to normal, and EPS developed in 2 patients. The eFDP level was high when dialysis was introduced, but returned to normal in 2 of the remaining 14 patients. In 1 of the 14 cases, peritonitis developed 5 times, followed by rapid elevation in the eFDP level. The patient with this intractable peritonitis was switched to hemodialysis. The other 11 patients received no steroid therapy. In 1 of these 11 patients, the eFDP level declined, but not in the others. We suggest that active steroid therapy for patients with a high level of eFDPs may prevent EPS development.