【Purpose】The purpose of this study was to investigate the differences in the physical function levels of patients with end-stage kidney disease (ESKD) according to the therapeutic modalities employed. 【Methods】The study population comprised 93 patients with ESKD (mean age, 66.1 years; 55 males). The patients were divided into three groups according to the therapeutic modality that they were treated with: the non-dialysis (ND) (36 patients), peritoneal dialysis (PD) (26 patients), and hemodialysis (HD) (31 patients) groups. The patients’ background data and physical function indices (knee extensor muscle strength, handgrip strength, one-leg standing time, and gait speed) were investigated and compared among the three groups. 【Results】In the ND, PD, and HD groups, knee extensor muscle strength values of 0.51±0.10, 0.46±0.11, and 0.43±0.12 kgf/kg; one-leg standing times of 40.7±21.0, 47.8±18.1, and 27.8±22.6 sec; and gait speeds of 1.85±0.28, 1.81±0.37, and 1.57±0.34 m/sec, respectively, were recorded. The HD patients exhibited significantly lower values for these indices compared with the other two groups (p<0.05). However, there was no significant difference in handgrip strength among the three groups (p=0.62). 【Conclusions】This study clearly showed that among patients with ESKD, only those undergoing HD displayed reduced physical function levels.

Denosumab treatment was administered to hemodialysis outpatients who were complicated with osteoporosis (young adult mean:<70%). Thirty-eight consecutive patients (13 males, 25 females; mean age: 70.8 years; range: 23-94 years) were recruited into this study. Sixty mg of denosumab were administered subcutaneously every 6 months. Twelve months later, the patients’ bone mineral density (BMD) at the 1/3 distal radius was significantly increased (by 4.63±7.07%). The levels of tartrate-resistant acid phosphatase 5b (TRACP-5b, a bone absorption marker) and total procollagen I intact N-terminal (P1NP, a bone formation marker) were significantly reduced after the administration of denosumab for more than 12 months. Although the patients’ albumin-adjusted calcium (Ca) levels decreased rapidly until the second or third week of denosumab treatment, their hypocalcemia gradually improved after the administration of a Ca and vitamin D preparation. The albumin-adjusted Ca, inorganic phosphate, and intact-parathyroid hormone (intact-PTH) levels detected after the second administration of denosumab were significantly lower than those recorded after the first administration of the drug, and therefore, the need for Ca adjustment could be reduced by half. In addition, the patients’ intact-PTH, TRACP-5b, and total P1NP levels were correlated with the reductions in their albumin-adjusted Ca levels. Denosumab treatment improved BMD at the 1/3 distal radius in hemodialysis patients that were complicated with osteoporosis.

Case 1: This case involved a 43-year-old female patient (original renal disease: diabetic nephropathy, hemodialysis duration: 5 years). She was admitted to our hospital to undergo treatment for right foot gangrene. At the time of her hospitalization, we detected multiple painful nodules on her abdominal region, which gradually progressed to multiple painful skin ulcers. The diagnosis was made based on a skin biopsy, which showed the typical findings of calciphylaxis (annular calcium deposition in the media of the small arteries). She was treated by adjusting her calcium (Ca) and phosphorus (P) levels and administering topical treatment and intravenous antibiotics; however, she ultimately died of sepsis. Case 2: This case involved a 42-year-old female patient (original renal disease: diabetic nephropathy, hemodialysis duration: 3 years). She was admitted to our hospital to undergo treatment for an intractable skin ulcer of the left toe. The diagnosis was made based on the pathological findings of a sample obtained during a local operation, which showed the typical findings of calciphylaxis. She was treated by discontinuing her warfarin therapy, adjusting her Ca and P levels, and administering topical treatment. Thereafter, her calciphylaxis lesion successfully improved. Calciphylaxis is a potentially fatal complication of end-stage renal disease and is characterized by medial calcification and intimal proliferation of the small arteries. Given that calciphylaxis is a rare disease, it is not easily recognized. However, calciphylaxis can cause intractable skin ulcers, so it should be considered during the differential diagnosis of hemodialysis patients with skin ulcers.