We previously detected bacterial contamination in the metal parts of a degassing pump of a dialysis console, which exhibited corrosion. In this study, we compared the numbers of Pseudomonas aeruginosa bacteria in dialysis fluid that had been incubated with or without corroded metal degassing pump parts. A significantly higher number of P. aeruginosa bacteria were detected in the dialysis fluid incubated with corroded metal parts than in the dialysis fluid incubated with uncorroded metal parts (p<0.05). Furthermore, when metal pumps with or without corrosion were installed in a central dialysis fluid delivery system a significantly higher number of P. aeruginosa bacteria were detected in the terminal dialysis fluid from the corroded pump than in the terminal dialysis fluid from the uncorroded pump (p<0.01). Dialysis pump surface corrosion might lead to bacterial contamination of terminal dialysis fluid.

Recently, the use of the tunneled cuffed catheter (TCC) as a hemodialysis access point has increased. The long-term courses of 235 consecutive patients who had the TCC inserted at our hospital between June 2000 and December 2012 were studied. A total of 275 catheters were inserted. The catheter insertion was performed under fluoroscopy and ultrasound guidance. The exit site was disinfected according to the Centers for Disease Control and Prevention (CDC) guidelines. During bathing, the catheter and exit site were protected with vinyl, but only 3 patients took showers. For catheter thrombosis, thrombolysis was performed using urokinase. The indications for catheter insertion included arteriovenous fistula/arteriovenous graft construction difficulties (59.6%), heart failure (11.3%), bridge formation (5.1%), and others (24.0%). All 3 patients who took showers developed exit-site infections. The incidence rates of exit-site/tunnel infections and bloodstream infections were 0.27 and 0.18 per 1,000 catheter days, respectively. There were no infections in the cases in which catheters were used as bridges. Four patients (1.7%) died due to septicemia caused by a catheter infection. The patient survival rate was 67.0%, 48.2%, and 25.3% at 6 months, 1 year, and 2 years, respectively. Catheters were removed in 63 of 275 cases (22.9%). Among these 63 cases, thrombosis occurred in 11 cases, and fibrin sheathes formed in 4 cases. The catheter patency rate was 76.1% and 65.5% at 1 and 2 years, respectively. The most common TCC management problems were infections and dysfunction. CDC guideline-based catheter care resulted in low bloodstream infection and exit-site/tunnel infection rates. As the 1-year patency rate was 76.1%, the TCC seems to be a useful hemodialysis access point. The TCC is considered to be a useful hemodialysis access point for elderly patients in whom access point creation is difficult because it exhibits low infection and high patency rates.

We sent out a follow-up questionnaire (first survey: Nov. 2011) to better understand the issues regarding dialysis facilities’ acceptance of human immunodeficiency virus (HIV) -infected patients. The questionnaire was sent to 3,871 hemodialysis (HD) facilities in Japan, and 1,728 facilities responded (response rate: 44.64%). In October 2017, 124 HIV-infected patients underwent dialysis in Japan. A total of 147 facilities (8.5%) accepted HIV-infected patients for HD, while 1,571 facilities (90.9%) did not. Of the 147 HD facilities, 57.1% first accepted HIV-infected HD patients after the first survey, 31.3% accepted such patients both before and after the first survey, while 7.5% only did so before the first survey. Of the HD facilities that had never accepted HIV-infected HD patients, 22.3% would accept such patients if they were referred, and 33.2% would plan to accept HIV-infected patients in future. In contrast, 44.2% HD facilities ruled out future acceptance of HIV-infected HD patients. In conclusion, since our previous survey in 2011 more HD facilities (147 vs. 94) have started accepting HIV-infected HD patients, but only 298 HD facilities (17.2%) stated that they better understood the issues surrounding the acceptance of HIV-infected HD patients. Taken together, the acceptance of HIV-infected HD patients did not appear to have markedly progressed in Japan. There are still some problems to overcome, and therefore, we should continue activities aimed at facilitating understanding about HIV infections and the acceptance of HIV-infected patients among the physicians and healthcare workers at HD facilities.

Ferric citrate (FC) is a new iron-containing phosphate binder, which has the potential to ameliorate anemia via iron supplementation. In this study, existing phosphate binders were replaced or used in combination with FC when treating hemodialysis patients with hyperphosphatemia or suspected iron deficiency. Then, the resultant changes in chronic kidney disease (CKD)-mineral and bone disorder (MBD)-related data (albumin-adjusted calcium, phosphate, alkaline phosphatase, and intact-parathyroid hormone levels), anemia (hemoglobin levels), iron metabolism (Fe, transferrin saturation, and ferritin levels), and total drug costs (oral medicines and injected drugs) were investigated. Twenty-four hemodialysis patients who exhibited suspected iron deficiency or gastrointestinal problems after treatment with other phosphate binders at our outpatient clinic were chosen. While no significant changes in their CKD-MBD-related laboratory data were detected after the FC treatment, significant improvements in anemia and iron metabolism-related laboratory data were seen at all observation points. Monthly oral medicine usage increased significantly after additional FC treatment. On the other hand, injected drug and total drug costs decreased significantly due to reduced use or the discontinuation of erythropoiesis-stimulating agents. The average reduction in monthly total drug costs was approximately 15,000 yen. The use of FC as a phosphate binder significantly ameliorated anemia and reduced medical costs.

【Purpose】 We investigated the optimal load and duration of muscular reinforcing exercises for hemodialysis (HD) patients. 【Method】 We instructed HD patients to undergo lower limb muscular reinforcing exercises 3 times a week. The exercise load was set at 50% (n=13) or 20% (n=12) of 1 repetition maximum (RM) in study 1, which lasted for 3 months, whereas it was set at 75% (n=12) or 40% (n=8) of 1RM in study 2, which lasted for 6 months. In each group, we evaluated the amount of skeletal muscle in the lower limbs, the percentage creatinine generation rate (%CGR), serum albumin level, Kt/V, 10-meter walking speed, and muscular strength during lower limb extension, and performed the Functional Reach Test (FRT) and Timed Up & Go Test (TUG). 【Results】 Study 1: The amount of skeletal muscle in the lower limbs, 10-meter walking speed, and the results of the FRT and TUG were significantly improved in the 50% group. No significant changes were seen in the 20% group. Study 2: The %CGR in the 75% group and the %CGR and serum albumin level in the 40% group were significantly improved. 【Conclusion】 Performing muscular reinforcing exercises involving loads and durations that are appropriate for each HD patient’s needs seems to aid the creation of more personalized rehabilitation programs.

The occurrence of whole urinary tract urothelial cancer in patients on maintenance dialysis is rare. We report a case of bilateral renal pelvic cancer, bilateral ureteral cancer, and bladder cancer in a maintenance dialysis patient. A 63-year-old female, who had undergone hemodialysis for 28 years, was referred to our hospital due to episodes of asymptomatic gross hematuria and an abnormal urinary cytodiagnosis. A cystoscopic examination revealed a papillary tumor and edematous changes in the bladder. Washing cytodiagnosis of the bladder revealed class IIIb findings. A biopsy sample of the tumor was pathologically diagnosed as urothelial carcinoma. Computed tomography scans revealed bilateral hydronephrosis, slightly enhanced tumors in the bilateral renal pelvis, bilateral ureteral wall thickening, and left-sided renal hilus lymph node enlargement. The bladder was unevaluable, as the patient had an artificial hip joint. Retrograde pyelography revealed filling defects of the bilateral renal pelvis and ureters. Complete urinary tract exenteration was carried out. At 20 postoperative months, right pulmonary apex metastasis and local recurrence were detected, and so radiotherapy was administered. At 9 months after the radiotherapy, the metastatic lesions had enlarged, and the patient died 22 months after the radiotherapy.