We surveyed the current situation of patients on peritoneal dialysis (PD) who require support. We sent questionnaires to Japanese PD facilities nationwide and obtained 475 responses. It was found that 173 PD facilities (36.4%) followed up PD patients who are unable to perform PD by themselves. The people who assisted the non-self-sufficient PD patients included their spouses (42.5%), sons or daughters (36.0%), and nurses (15.0%), etc. There were 64 PD facilities that followed up PD patients who did not perform PD at their home or office. Among the 73 non-self-sufficient PD patients, PD was most often performed at medical facilities (hospitals and clinics). There were 88 facilities (38.5%) that had accepted long-term admissions (over 3 months) for PD patients. The following opinions were extracted from the freely reported comments in the questionnaire: it’s necessary 1) to further enhance the support system for patients who undergo PD at home and 2) to increase the number of care facilities or similar facilities besides hospitals that can accept non-self-sufficient PD patients. The current situation of aged PD patients was disclosed by this survey, and various ways in which the support system for PD patients could be improved should be discussed in the near future.

Percutaneous transluminal angioplasty (PTA) for blood flow disturbances in arteriovenous fistulas has become a widely accepted technique and has been recommended as the first-line treatment for maintaining vascular access (VA), but the increased restenosis rate seen after balloon angioplasty remains a problem. Target lesion restenosis after PTA is mainly caused by neointimal proliferation associated with the repair of the injured intima and media. We studied optical coherence tomography (OCT) images obtained before and after PTA for restenosis lesions using non-compliant balloons, semi-compliant balloons, and scoring balloons, such as the Cutting balloon, NSE balloon, and AngioSculpt balloon. The OCT images showed large dissection lesions and a lot of intimal damage after PTA was performed using non-compliant or semi-compliant balloon, which are inflated rapidly. However, less intimal damage was caused by the non-compliant balloon, Cutting balloon, NSE balloon, and AngioSculpt balloon, which are inflated slowly at a minimal inflation pressure. The findings of OCT are useful for evaluating intimal damage after PTA for restenotic VA lesions.

In this study, 21 dialysis patients who were administered sucroferric oxyhydroxide (SO) were examined. They were treated at Suzuki Clinic (Enjinkai Group) using a phosphate binder, but not iron. The phosphate binder was switched to SO at the same dose. The serum phosphorus level, the levels of iron metabolism markers, the frequency of side effects, and the serum fibroblast growth factor 23 (FGF23) level were measured before and 12 weeks after the switch and compared. The serum phosphorus levels of the 18 patients who were able to continuously take SO decreased significantly. Three patients stopped taking SO because of side effects (diarrhea, two patients ; loose stools, one patient). No significant changes in the levels of iron metabolism markers were seen after the switch. The change in the serum FGF23 level depended on the predialysis serum phosphorus level.

Here, we report a case of occult cryptococcuria involving the delayed development of cryptococcal meningitis after the initiation of hemodialysis. The patient was a 72-year-old Japanese male. His medical history included diabetes and hypertension. At the age of 71, he developed tubulointerstitial nephritis, and steroid treatment was started. However, he needed to start hemodialysis therapy due to progressive kidney dysfunction 7 months later. On admission for the initiation of hemodialysis, his laboratory data showed elevated inflammatory marker levels, and Cryptococcus neoformans was isolated from his urine. However, we decided to follow him without providing any specific therapy because a re-examination of his inflammatory marker levels and a urinary culture produced negative findings. He was hospitalized for fever and personality changes 34 days after the initiation of hemodialysis therapy. Cryptococcus was isolated from his spinal fluid, and he was diagnosed with cryptococcal meningitis. He was treated with liposomal amphotericin B and flucytosine, which cured his meningitis. The combination therapy was switched to fluconazole, and he was discharged. Hemodialysis patients are immunocompromised, and hence, are at high risk of infectious diseases, including cryptococcosis. Cryptococcuria can co-exist with systemic cryptococcosis, and therefore, should be followed closely.

We experienced a case in which the colonic melanosis of a patient on long-term dialysis was improved by the administration of lubiprostone. The patient was a 79-year-old male who was receiving 24 mg of sennoside daily (a single oral dose) for constipation. As the patient’s defecation control remained poor, he underwent colonoscopy to exclude organic disease. On colonoscopy, no stenotic lesions, such as colon cancer, were found, but melanosis was identified throughout the entire colon. The administration of sennoside was discontinued, and the oral administration of lubiprostone was started, after which the patient’s defecation control improved. As patients on dialysis have a high prevalence of constipation, anthraquinone-based drugs, such as sennoside, are frequently used. However, the long-term use of anthraquinones carries a risk of melanosis coli, which can in turn be a risk factor for colon adenoma and colon cancer. The administration of lubiprostone to dialysis patients with colon melanosis might improve their constipation and colon melanosis.