【Background】The application of chronic hemodialysis treatment (HD) to patients who are affected by both advanced chronic kidney disease (CKD) and cancer is not fully understood. The mortality of those who undergo chronic HD is still unknown. 【Subjects and Methods】The clinical characteristics and mortality of 34 CKD cancer patients who underwent chronic HD were retrospectively studied. Cumulative mortality was analyzed by Kaplan-Meier analysis, stratified by the presence or absence of cancer care following HD initiation. Data of the cancer patients were compared with those of 34 controls (age, gender, and prevalent diabetes mellitus were matched), namely, non-cancer CKD patients who underwent chronic HD. In addition, the differences in clinical characteristics between the cancer patients who received adequate cancer care and those who did not were studied. 【Results】Mean patient age was 70.4±8.8 years. Mean hemoglobin level was significantly lower in the cancer patients than in the non-cancer control patients (8.1±1.3 g/dL versus 9.2±1.0 g/dL). New cancers were diagnosed in 11 CKD patients by routine screening examinations at the time of admission for HD initiation. The cumulative 1-year, 3-year, and 5-year survival rates after HD initiation in the cancer patients were 67.5%, 47.7%, and 21.1%, but 100%, 83.0%, and 73.8% in the controls, respectively. Moreover, the 1-year, 3-year, and 5-year cumulative survival rates were 93.3%, 68.9%, and 46.0% in the treated cancer patients, but 42.4%, 28.2%, and 0% in the untreated ones, respectively. In the 16 treated cancer patients, 9 patients were affected by digestive organ cancers and 5 patients by urinary organ cancers. 【Conclusions】The mortality of cancer patients who undergo chronic HD is likely to be better in patients who are able to receive adequate care for cancer following HD initiation.

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A 61-year-old man had been diagnosed with myasthenia gravis (MG) 30 years previously and had undergone a thymectomy at that time, resulting in a diagnosis of thymoma. Although the MG had stabilized in response to treatment with only 100 mg of cyclosporine during the last 3 years, the patient developed minimal change nephrotic syndrome (MCNS), as confirmed by histological examination, and acute kidney injury. Treatment with 40 mg of oral steroid therapy and three days of 1-g steroid pulse therapy had no effect on the patient's condition. However, 5 sessions of low-density-lipoprotein apheresis (LDL-A) therapy at 52 hospital days after the diagnosis of nephrotic syndrome promptly led to complete remission. Low-dose oral steroid and cyclosporine therapy have enabled the complete remission to be maintained for one year. The development of nephrotic syndrome a long period after the diagnosis of MG and the performance of a thymectomy has often been reported. Although MG-associated MCNS generally occurs after steroid therapy or treatment with immunosuppressive drugs, this is the first case of the development of nephrotic syndrome during cyclosporine therapy for MG. The cyclosporine that the patient had taken because of MG did not prevent the development of nephrotic syndrome in this case, and LDL-A therapy had a significant effect on the steroid resistance. These findings suggest that the reduction of high lipoproteinemia by LDL-A easily led to complete remission because of changes in the sensitivity to steroid and immunosuppressive drugs. Therefore, LDL-A can be considered as a strong supportive therapy for MG-associated MCNS in patients who are resistant to steroid and immunosuppressive drugs.

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We report two cases in which brachial artery ligation was effective for sudden massive bleeding due to brachial vascular access infection. Case 1 : A 47-year-old male was referred to our hospital for pain in a right brachial vascular access arteriovenous shunt. On admission, an aneurysm was found at the anastomosis of the brachial arteriovenous shunt. At this aneurysm, redness and swelling were shown. Blood test and imaging studies led to a diagnosis of arteriovenous shunt infection. After admission, the aneurysm ruptured and brachial artery ligation was performed in an emergency room. Case 2 : A 74-year-old male showed redness and pus discharge at a residual brachial arteriovenous graft portion after treatment of seroma. Although the infectious graft was removed, massive bleeding was seen after a few days. In an emergency room, he underwent brachial artery ligation. For the collateral artery, blood flow in the periphery was shown in 3D contrast CT and angiography. On the basis of these cases, we suggest that brachial artery ligation is useful as emergency surgery for rupture bleeding due to vascular access infection.

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