【Purpose】The aim of this study was to clarify the effects of resistance training (RT) during hemodialysis (HD) therapy on physical function and nutritional status in patients receiving HD with malnutrition. 【Methods】We studied 75 ambulant HD patients (47 male, 28 female, age 63±13 years old). They were divided into 2 groups according to the Geriatric Nutrition Risk Index (GNRI) at the beginning of RT : 19 patients in the MN group (GNRI<91) and 56 patients in the C group (GNRI≧91). We assessed Short Physical Performance Battery (SPPB) and performed Life Space Assessment (LSA) as indicators of physical function, as well as measuring serum albumin (Alb) and GNRI as indicators of nutritional status at the beginning and after 9-month RT during HD therapy. 【Results】SPPB score, LSA score, Alb and GNRI at the beginning of RT in the MN group were significantly lower than those in the C group (p<0.05). However, SPPB score, LSA score, Alb and GNRI after 9-month RT in the MN group were significantly improved (p<0.05), at which time SPPB score and LSA score no longer differed significantly between the MN group and the C group. 【Conclusion】RT during HD therapy is feasible for improving physical function and nutritional status in hemodialysis patients with malnutrition.

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We investigated the effect of enteric capsules containing Bifidobacterium longum JBL01 on the constipation and variation of QOL (quality of life) in hemodialysis patients. These enteric capsules were administered orally to 24 patients on HD for 8 weeks. CAS (Constipation Assessment Scale) was used for measuring the degree of constipation, and PAC-QOL was used for measuring the influence of constipation on QOL. In the present study, constipation was significantly improved in 21 patients (87.5%) and was not improved in 3 patients (12.5%). The score of PAC-QOL was significantly low compared with that prior to the intake of enteric capsules containing Bifidobacterium longum JBL01. The serum phosphorus values of the group that had improved constipation at an early stage were significantly reduced compared with those before the intake of enteric capsules containing Bifidobacterium longum JBL01. These results suggest that the intake of enteric capsules containing Bifidobacterium longum JBL01 is useful to improve the intestinal environment and QOL of hemodialysis patients, and to reduce the serum phosphorus values.

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We previously reported that the phosphorus (P) and potassium (K) contents of rice can be effectively decreased by washing it 5 times (20 sec with swirling/wash), with a change of water between each wash. In this study, we evaluated the clinical effectiveness of this procedure. Seven hyperphosphatemic dialysis patients (pre-instruction serum P levels ≥5.0 mg/dL) who consumed white rice twice or three times a day at home were instructed to wash their rice 5 times and followed for 18 weeks to evaluate changes in their blood test results (BUN, P, K, Alb, and Hb) before and after the instructions. No significant changes were observed in BUN, K, Alb, or Hb levels, while P levels tended to decrease over time, with a significant decrease from the pre-instruction values being noted at 10, 14, and 16 weeks of follow-up (p<0.05). The lack of marked changes in the Alb and Hb levels suggested that the rice-washing procedure had no negative effects on the nutritional status. This simple dietary modification can be continued for a prolonged period and may have the potential to reduce serum P levels.

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In Japan, the number of patients receiving maintenance hemodialysis has increased to 310,000. Consequently, the incidence of critical limb ischemia (CLI) is also increasing. Major limb amputations due to CLI have a considerable adverse effect on the prognosis for survival. Therefore, the therapeutic goal for CLI is to avoid lower limb amputations and retain walking function as much as possible in order to improve prognosis. We report a case of thromboendarterectomy (TEA), one of surgical revascularization procedures, that was performed successfully to save an affected lower limb of a patient with CLI on maintenance hemodialysis. The subject was a 64-year-old man. In June 2003, he started receiving treatment with peritoneal dialysis for chronic renal failure resulting from polycystic kidney disease. The treatment was switched to hemodialysis in June 2009. In early 2014, intermittent claudication occurred in the right lower limb. The patient’s condition was exacerbated around May with the development of rest pain. Because discrete lesions were found in the right common femoral and popliteal arteries on lower extremity angiography, we performed TEA in June 2014, by which the symptoms improved. Our study results indicate that TEA is a potentially effective treatment option for discrete lesions in hemodialysis patients with CLI.

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A 45-year-old female with a history of chronic renal disease attended our hospital in 2008 with acute intermittent porphyria (AIP). The following year, her renal function deteriorated, and her general condition, and clinical and laboratory findings fulfilled the Japanese criteria for hemodialysis. The porphyrias are metabolic disorders of heme biosynthesis that are triggered and worsened by a number of different drugs. Hemodialysis was initiated in 2009, and we prescribed amlodipine besylate and epoetin beta, paying particular attention to drug safety. Currently, the patient is on hemodialysis and is still taking the medications mentioned above, without any exacerbation of porphyria.

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A 74-year-old man with diabetes mellitus, hypertension and dyslipidemia was referred to our department due to the deterioration of renal function, proteinuria and hematuria. From his symptoms and laboratory findings, we suspected systemic lupus erythematosus (SLE) and planned an additional examination. However, he was admitted to our hospital due to fever and acute renal failure with severe hyperkalemia before the next consultation day. Acute exacerbation of lupus nephritis was suspected. We started oral prednisolone with continuous hemodialysis for the treatment of the hyperkalemia. Since his symptoms and examinations fulfilled the diagnostic criteria of SLE, he was diagnosed with late-onset SLE and lupus nephritis. Although his condition improved after the treatment with prednisolone, pancytopenia and hypocomplementemia were not improved. We then added mizoribine to the prednisolone. However, the pancytopenia and hypocomplementemia continued. We therefore initiated immunoadsorption plasmapheresis (IAPP). After this IAPP treatment, his symptoms and laboratory findings improved without recurrence. This case indicates that IAPP is one of the effective options for the treatment of lupus nephritis, especially in elderly patients, to lower the risk of immunosuppressant-related adverse events.

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A 69-year-old male who had received hemodialysis since 1989 was referred to our hospital for treatment of right renal tumor. He had undergone left laparoscopic radical nephrectomy for left renal cell carcinoma in April 2011. Twenty months after this surgery, an abdominal computerized tomogram (CT) demonstrated the presence of a right well-enhanced solid mass in acquired cystic disease of the kidney (ACDK). The size of the renal tumor was increasing, reaching 1.0 cm in diameter, and it was clinically diagnosed as right renal cell carcinoma. Right laparoscopic radical nephrectomy was performed under general anesthesia. The right renal tumor was histologically diagnosed as renal capillary hemangioma. It is difficult to diagnose a renal capillary hemangioma in a patient having ACDK before surgery. To our knowledge, this is the fifth case of renal hemangioma in a patient on long-term hemodialysis in the Japanese literature.

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A 52-year-old woman had continually felt ill after meals since she had undergone total gastrectomy for gastric cancer 10 years earlier. However, the condition was left untreated. In September 2012, the subject was started on hemodialysis for end-stage renal failure (unknown underlying disease, without diabetes), and she was receiving continuous maintenance dialysis on an outpatient basis at our hospital. In May 2013, the subject went into a hypoglycemic coma after breakfast, which was improved by intravenous glucose infusion. As the subject did not wish to be hospitalized for a detailed examination, she underwent continuous glucose monitoring (CGM) on an outpatient basis. On the basis of postprandial hypoglycemia revealed by CGM and the fact that the subject had undergone gastrectomy, a diagnosis of late dumping syndrome was made. Treatment was initiated with the oral administration of voglibose at a dose of 0.3 mg following breakfast and dinner, and the subjective symptoms and blood glucose fluctuations on CGM improved. We hereby report on this valuable case of late dumping syndrome in a patient receiving hemodialysis in which CGM confirmed the improvement in blood glucose fluctuation by voglibose treatment.

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