Cinacalcet is used as an oral agent for maintenance dialysis patients with secondary hyperparathyroidism (2HPT); however, some patients find it difficult to continue taking cinacalcet because of problems such as upper gastrointestinal disorders. In this study, we aimed to calculate the proportion of days covered (PDC) and prescription persistence rate of cinacalcet using electric healthcare records from Japan and to investigate the factors that affect the prescription persistence rate of cinacalcet using Cox regression analysis. A total of 2,637 2HPT patients who were prescribed cinacalcet and underwent maintenance dialysis for more than 1 year were analyzed. The median PDC was 96.2%. The prescription of cinacalcet was interrupted in 488 patients (18.5%), and the prescription persistence rate of cinacalcet was about 90% and about 75% at 1 and 3 years after the initial prescription of the drug, respectively. The factors associated with more continuous use of cinacalcet included not being elderly, having no history of fractures, suffering fewer complications, being prescribed a larger number of phosphorus binders, and a facility permitted to use 12.5 mg cinacalcet tablets. In clinical practice, the compliance and prescription persistence rates of the oral calcimimetic cinacalcet were good. It was suggested that the use of a low dosage of cinacalcet improves the prescription persistence rate of the drug.

【Purpose】 We examined the associations between quadriceps femoris muscle thickness (QT) and physical functions in hemodialysis patients. 【Subjects and Method】 The subjects were 182 hemodialysis patients. We measured QT with ultrasonography and also assessed handgrip force and walking speed. Then, we investigated the reliability of ultrasonographic QT measurements and the associations between QT and physical function in each gender. 【Results】 The QT measurements obtained using ultrasonography exhibited high intra-rater reliability. Furthermore, we found that QT was correlated with grip force and maximum walking speed in males, but was only correlated with the maximum walking speed in females. 【Conclusion】 Ultrasonographic QT measurements are useful for assessing renal rehabilitation in hemodialysis patients because ultrasonography places less burden on the patient, and such measurements are highly reliable and are associated with physical functions.

A 38-year-old male suffered exertional heat stroke after running 10 km on a sunny day in April and became comatose. He was sent to hospital by ambulance. He received supportive treatment, such as cooling and intravenous infusions. During the first 24 hours, although his consciousness status and general condition improved, his serum aspartate aminotransferase (AST) and creatine phosphokinase (CPK) levels increased markedly. His liver function deteriorated steadily after he was transferred to our hospital. He exhibited AST, alanine aminotransferase (ALT), and creatinine levels of 11,730 U/L, 6,509 U/L, and 0.87 mg/dL, respectively; a platelet count of 4.7×10⁴/μL; and a prothrombin level of 17%. We performed plasma exchange (PE) and continuous hemodiafiltration (CHDF) for disseminated intravascular coagulation and acute liver failure. The patient’s AST and ALT levels gradually decreased. He was discharged from our hospital 18 days after his admission. Severe liver failure due to exertional heat stroke typically occurs at 3 days after onset. We experienced a case of acute liver failure induced by heat stroke, which was successfully treated with PE and CHDF.

Allergies are common in dialysis patients, and allergies caused by dialysis membranes and anticoagulants have occasionally been reported. Herein, we report a case in which it was suspected that an allergy had been caused by a bicarbonate dialysate containing acetate. A 77-year-old male patient developed a fever, generalized erythema, diarrhea, and an increased peripheral blood eosinophil count (7,730/μL) after the initiation of dialysis treatment. A skin biopsy showed neutrophil, eosinophil, and lymphocyte infiltration at perivascular sites in the epidermal layer, which was consistent with the findings obtained in cases of allergic drug eruptions. Suspecting an allergy, the dialysate was changed to a dialysate that did not contain acetate. However, the patient’s symptoms persisted, and treatment with prednisolone was started at a dose of 40 mg/day. As a result, the fever, skin rash, and diarrhea resolved, and the patient’s eosinophil count returned to the normal range. A positive result was obtained during a drug lymphocyte stimulation test (DLST) conducted using the acetate-containing bicarbonate dialysate. In addition, re-use of the acetate-containing bicarbonate dialysate caused the allergy symptoms to relapse. Thus, it was concluded that the acetate-containing dialysate had caused the allergic symptoms. Allergies attributable to acetate-containing bicarbonate dialysates can become serious, although there are few reports about such allergies. When allergy symptoms occur in dialysis patients, the composition of the dialysate should be considered when attempting to identify the causative allergen, and the DLST is considered to be useful for determining the causative allergen in such cases.

A 66-year-old male developed a fever that was refractory to antibiotic therapy. He received the antibiotic therapy during long-term hospitalization because it was challenging for him to receive home care. He had been diagnosed with chronic kidney disease and had been undergoing maintenance hemodialysis. He was referred to our hospital and was admitted to undergo a detailed examination. A computed tomography scan showed ascites, and the ascitic fluid exhibited an elevated adenosine deaminase level. These findings suggested peritoneal tuberculosis, but the Mycobacterium tuberculosis-specific interferon-gamma release assay (IGRA) produced a negative result. Diagnostic laparoscopy showed peritonitis with peritoneal micronodules. Peritoneal biopsy cultures confirmed the diagnosis of peritoneal tuberculosis. Treatment was initiated using anti-tuberculous drugs, including isoniazid, rifampicin, ethambutol, and pyrazinamide, following which the patient’s fever disappeared. Even though the IGRA is a useful tool for diagnosing tuberculosis, it might infrequently yield false-negative results. The aggressive application of diagnostic laparoscopy is imperative for the accurate diagnosis and treatment of suspected peritoneal tuberculosis.

Recently, the use of simple plasma exchange (sPE) with fresh frozen plasma to treat kidney disease has been replaced with selective plasma exchange (SePE) with albumin solution due to the efficacy, safety, and cost-effectiveness of the latter approach. SePE reduces the titer of the IgG anti-glomerular basement membrane (GBM) antibody, although it also partially removes some anticoagulant factors. Here, we report the case of a patient who was positive for the anti-GBM antibody, who we treated with a combination of sPE and SePE. The combination treatment reduced the patient’s anti-GBM antibody level to 10 U/mL, but did not affect his anticoagulant factor levels. As there have been few reports regarding combination treatment with sPE and SePE, we summarize the merits and demerits of this approach.