The annual survey of Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) was conducted for 4,396 dialysis facilities at the end of 2016, among which 4,336 facilities (98.6%) responded. The response rate of the 2016 survey was comparable with the past, even though it was the second year after the new anonymization method. The number of chronic dialysis patients in Japan continues to increase every year; it has reached 329,609 at the end of 2016. The mean age was 68.15 years. The prevalence rate was 2,597 patients per million population. Diabetic nephropathy was the most common primary disease among the prevalent dialysis patients (38.8%), followed by chronic glomerulonephritis (28.8%) and nephrosclerosis (9.9%). The rate of diabetic nephropathy and nephrosclerosis has been increasing year by year, whereas that of chronic glomerulonephritis was declining. The number of incident dialysis patients during 2016 was 39,344; it has remained stable since 2008. The average age was 69.40 years and diabetic nephropathy (43.2%) was the most common cause in the incident dialysis patients. The incidence of diabetic nephropathy has been stable for recent several years. 31,790 patients died in 2016; the crude mortality rate was 9.7%. The patients treated by hemodiafiltration (HDF) have been increasing rapidly from the revision of medical reimbursement for HDF therapy in 2012. It has attained 76,836 patients at the end of 2016, which were 21,503 greater than that in 2015. The number of peritoneal dialysis (PD) patients was 9,021 in 2016, which was slightly decreased from 2015. 20.3% of PD patients treated in the combination of hemodialysis (HD) or HDF therapy. 635 patients were treated by home HD therapy at the end of 2016; it increased by 63 from 2015.

Prolonged peritoneal dialysis (PD) causes progressive morphological changes (i.e., the deterioration of the peritoneal membrane), leading to an increased risk of encapsulating peritoneal sclerosis (EPS). Histological assessments of peritoneal membrane biopsy samples are required to evaluate the peritoneal damage caused by PD. To evaluate the serial morphological changes induced in the peritoneum by PD, peritoneal biopsy examinations should be performed not only after the cessation of PD, but also before performing PD. During PD catheter insertion, the parietal peritoneum (1.5×1.5 cm) and the posterior sheath of the rectus abdominal muscle should be sampled at 3 cm below the PD catheter insertion site. Also, during PD catheter removal the parietal peritoneum should be sampled at 3 cm from the PD catheter insertion site. The peritoneum should be examined for mesothelial cell denudation, acellular sclerotic changes, vasculopathy, vascular angiogenesis, and new encapsulating membranes, and the thickness of the submesothelial connective tissue should also be assessed. The method presented herein allows artifacts to be minimized and peritoneal biopsy examinations to be performed safely. Morphological evaluations of the peritoneum involving an appropriate biopsy strategy, as well as functional markers of deterioration, such as peritoneal permeability or cytokine levels, is a useful means of examining peritoneal damage and predicting the onset of EPS.

【Objective】The aim of this study was to examine the effect of belt electrode skeletal muscle electrical stimulation (B-SES) during hemodialysis on physical function in frail hemodialysis patients. 【Methods】Eight hemodialysis patients (3 males and 5 females, mean age: 68.5±10.4 years old) were enrolled in this study. We assessed grip strength, the Berg Balance Scale (BBS), and knee extension muscular strength and conducted the 30-second chair stand test (CS30), 10 m walking test (10 mWT), and the 6-minute walk test (6 MWT). The B-SES intervention lasted for 20 minutes and was performed 3 times a week. 【Results】The subjects’ CS30, BBS, and 10 mWT results and knee extension muscular strength significantly improved and their 6 MWT results slightly improved after B-SES during hemodialysis. 【Conclusion】B-SES during hemodialysis exhibits a low dropout rate and is a feasible way of improving physical function in frail hemodialysis patients.

Hemodialysis-related carpal tunnel syndrome requires long-term therapeutic management because postoperative recurrence due to amyloidosis can occur multiple times. We used flexor digitorum superficialis (FDS) tendon resection surgery to treat patients who suffered multiple episodes of such recurrence and who no longer had releasable volar soft tissue available because of previous carpal tunnel release surgery. The postoperative results of these procedures were compiled and analyzed to reveal the optimal therapeutic strategy for such patients. We investigated 50 hands from 43 patients who underwent FDS tendon resection surgery due to multiple episodes of recurrent hemodialysis-related carpal tunnel syndrome. Subjective tingling was cured in 92% of hands, and pain and touch sensation disturbances disappeared in all hands. Preoperative abductor pollicis brevis muscle power scores (according to manual muscle testing) of 0, 1, 2, or 3 improved postoperatively to 4 or 5 in 56% of hands. Normalized distal latency was observed in 15% of motor nerves and 19% of sensory nerves. Postoperative recurrence was seen in 56% of hands after a mean of 5 postoperative years. Based on our clinical results, FDS tendon resection surgery can be selected when no releasable volar soft tissue is available in the carpal canal.

Exercise during hemodialysis increased the efficacy of solute removal in some studies. The goal of this study was to compare the removal of solutes between hemodialysis patients that did and did not perform aerobic exercises and to establish an effective protocol for exercise therapy during hemodialysis. We recruited 4 male patients that were undergoing online predilution hemodiafiltration (blood flow rate: 250 mL/min, total dialysate flow rate: 650 mL/min, substitution flow rate: 40 L/session, a constant body fluid removal rate, and an ABH-21P hemofilter). In the exercise sessions, the patients pedaled on a cycle ergometer for 60 minutes. The intensity of the exercise was set at peak VO₂ of 30, 40, 50, and 60%. The total and hourly dialysate and hourly blood samples were collected. The total amounts removed, clear spaces, and reduction rates of urea, potassium, phosphate, β₂-microglobulin, and α₁-microglobulin were calculated. Also, the levels of bone metabolic markers in the hourly blood samples were measured. The total clear space of phosphate was higher in the patients that performed low intensity exercise than in those that participated in moderate intensity exercise. Among all patients, the clear space of phosphate was slightly higher during the exercise hour than during the control hour. The exercise did not affect the removal of urea, potassium, β₂-microglobulin, or α₁-microglobulin or the levels of bone metabolic markers. These findings suggest that low intensity exercise could improve long-term phosphate control in hemodialysis patients.

The biological effects of calcium are determined by the ionized calcium concentration (iCa). However, since the iCa is not routinely measured in many guidelines evaluations of Ca concentrations are based on the total calcium concentration (tCa). The tCa accurately reflects the iCa in patients with normal albumin levels, but not in patients with hypoalbuminemia. The guidelines produced by the Japanese Society for Dialysis Therapy recommend correcting the tCa using Payne’s formula: corrected Ca=tCa+(4−albumin). The iCa, tCa, and serum albumin level were measured simultaneously just before the first dialysis session of the week. Among the 41 hemodialysis patients investigated, 33 had hypoalbuminemia (a serum albumin level of<3.7 g/dL) and were included in the analysis. Payne’s formula and two formulae recommended by the Kidney Disease Outcomes Quality Initiative (KDOQI; the KDOQI-1 and KDOQI-2 formulae) were used to estimate the iCa. The serum albumin level was measured using the modified bromocresol purple method. The measured albumin levels were converted using the conventional bromocresol green method by adding 0.3 mg/dL. The KDOQI-1 formula exhibited the highest specificity for predicting the iCa (R²: 0.50), followed by the tCa (R²: 0.45), the KDOQI-2 formula (R²: 0.44), and Payne's formula (R²: 0.37) in the 33 hemodialysis patients with hypoalbuminemia. In conclusion, this study suggested that the KDOQI-1 formula might be useful for predicting the iCa in hemodialysis patients with hypoalbuminemia.

A 29-year-old male with abdominal pain was transported to a local hospital. He was diagnosed with acute pancreatitis and admitted to the hospital. When his condition worsened to severe acute pancreatitis 2 days later, he was transferred to our hospital. On admission, his Japanese pancreatitis prognosis criteria score was 4, and his acute pancreatitis grade on computed tomography was 2. His serum triglyceride level was high (1,300 mg/dL), and his serum lipase, phospholipase A2, and elastase-1 levels were 1,279 IU/L, 3,880 IU/L, and 4,800 ng/mL, respectively. He exhibited low urine output, and his respiratory condition worsened. He was diagnosed with severe acute pancreatitis combined with hypertriglyceridemia, acute kidney damage, and respiratory failure. Treatments for the pancreatitis and hypertriglyceridemia were administered. In addition, acute blood purification therapy consisting of plasma exchange and high-flow, high-volume hemodiafiltration was administered. These treatments reduced the severity of the pancreatitis, suggesting that plasma exchange therapy is effective against severe acute pancreatitis combined with hypertriglyceridemia.