We evaluated the thyroid function of hemodialysis (HD) or continuous ambulatory peritoneal dialysis patients. Low free thyroxine (fT₄) and free triiodothyronine (fT₃) levels with a slightly elevated thyroid stimulating hormone (TSH) level and an almost unchanged fT₃/fT₄ ratio were the characteristic abnormalities seen in end-stage renal disease (ESRD) patients undergoing HD, which are suggestive of the typical model of carbohydrate-sufficient non-thyroidal illness. The prevalence of hypothyroidism compared with the reference values for ESRD patients was 1.4% (overt) or 10.3% (subclinical). After iodide restriction, the TSH levels of all patients significantly decreased within a month. The prevalence of hypothyroidism in chronic kidney disease (CKD) was 9% in CKD 1+2, 20% in CKD 3+4, and 56% in CKD 5 (non-dialysis-dependent). Excess ingestion of iodide combined with impaired iodide excretion might be responsible for the reversible thyroid dysfunction that is frequently seen in patients with renal dysfunction. Finally, the prevalence of thyroid nodules is high (59.4%) among ESRD patients undergoing HD.

【Background】Although low-potassium juices are commercially available, there are few methods for preparing them at home. 【Method】Batch processing was used to conduct a reaction between 100% orange juice and polystyrene sulfonate natrium. The electrolyte content of the juice was measured, and its taste was analyzed using a TS-5000Z taste sensor, in order to produce a low-potassium orange juice with an improved taste. 【Results】After 15 min, which was set as the reaction time, polystyrene sulfonate natrium had not markedly decreased the potassium concentration of the orange juice. The mean potassium concentration of 100 mL of orange juice that was reacted with 15 g polystyrene sulfonate natrium for 15 min was reduced to 15% of that of the undiluted orange juice. However, the analysis with the taste sensor indicated the loss of the acidic taste with the consequent gain of a delicious taste in the orange juice obtained following the reaction; this was caused by the decrease of the acidic taste. Therefore, approximately 0.1 g citric acid and 0.1 mL 50% glucose solution were added to 100 mL of the orange juice produced by the reaction, and the juice was further analyzed with the taste sensor. The taste sensor analysis revealed that a low-potassium orange juice with a similar taste to that of the undiluted orange juice had been successfully prepared. 【Conclusion】The abovementioned method can be employed to conveniently prepare low-potassium orange juice at home. Furthermore, this method might be applicable to the preparation of other drinks or soups.

We hypothesized that etelcalcetide would be more effective and cause fewer digestive symptoms than oral calcium receptor agonists (calcimimetics) in patients with secondary hyperparathyroidism. Etelcalcetide was administered to 32 hemodialysis patients. We assessed their serum whole-parathyroid hormone (PTH), calcium, and phosphorus levels, as well as their GSRS (Gastrointestinal Symptom Rating Scale) scores, and analyzed the changes in these parameters. As a result, we found that their whole-PTH levels significantly decreased within the first month of treatment. Approximately 70% of patients achieved their target level within a year. The subjects’ adjusted calcium levels immediately decreased, but gradually recovered. No significant changes in the GSRS were seen. These results demonstrate that etelcalcetide is effective at decreasing PTH levels and causes fewer digestive symptoms than calcimimetics. However, patients’ serum calcium levels should be closely monitored during etelcalcetide treatment.

【Purpose】We characterized the clinical features and outcomes of hemodialysis patients that were diagnosed with bladder tumors. 【Subjects and Method】Of the 2235 patients who had received maintenance dialysis treatment at 4 outpatient facilities from 1988 to 2017, 28 had a history of or had newly developed bladder tumors. Their clinicopathological data, including information regarding their age, sex, and chief complaint; the duration of hemodialysis; and the extent of cancer progression, were retrospectively reviewed. 【Results】Of the 28 patients, 16 were diagnosed before the initiation of dialysis. Specifically, bladder tumors were found due to gross hematuria in 14 patients and during follow-up imaging of ureteral stones or renal pelvic cancer in 2 patients. Twelve patients developed bladder tumors after the initiation of hemodialysis. Their diagnoses were based on gross hematuria in 6 patients, periodic ultrasound check-ups in 4 patients, and follow-up assessments in 2 patients with congenital hydronephrosis or renal pelvic cancer. Compared with the pre-dialysis patients, the detection of bladder tumors in maintenance hemodialysis patients tended to be more reliant on imaging. 【Conclusions】Regular ultrasonographic screening might aid the early detection of bladder tumors in chronic hemodialysis patients.

A 76-year-old male with IgA nephropathy had been undergoing hemodialysis since the age of 64. He developed back pain and a high-grade fever during dialysis as an outpatient and was admitted to our hospital. A blood examination revealed a marked inflammatory reaction, and so we started him on antibiotics. T2-weighted magnetic resonance imaging showed hyperintensity around the aorta from the level of the origin of the renal artery to the origin of the common iliac artery. Contrast-enhanced computed tomography (CT) demonstrated a poorly marginated region with increased CT attenuation values, which was indicative of panniculitis, around the aorta. Periaortic inflammation was suspected because the aorta itself remained unchanged on the imaging scans. There was also the possibility of coexisting infective aortitis, so we initially instituted antimicrobial treatment without steroids. The patient’s blood parameters and periaortic inflammation (monitored using follow-up CT) showed some improvement, but a rapidly enlarging aneurysm appeared at the origin of the left renal artery. Due to the risk of imminent rupture, stent placement was performed emergently. Thus, our working diagnosis was an infected aneurysm of the abdominal aorta caused by infective aortitis. It is difficult to distinguish between periaortic inflammation and infective aortitis, which require different treatments. This case provides a valuable clinical lesson because it was possible to monitor the progression of infective aortitis into an aneurysm.

Although home hemodialysis is expected to improve patients’ quality of life, it is not widely used due to various problems. For example, water quality management methods are not standardized. From April to May 2018, the Working Group of the Home Hemodialysis Study Group conducted a survey on dialysate management in the home hemodialysis setting at 89 facilities (635 patients). Responses were received from 435 patients (68.5%) being treated at 57 facilities (64.0%). After aggregating the data, it was found that 388 (89.4%) patients used tap water as raw dialysis water, but 7 (1.6%) used groundwater. Biological contamination was measured at 50 of 57 facilities (87.7%), but the frequency of such measurements varied from facility to facility. Only 25 facilities (43.9%) did not measure chemical contamination. These findings confirm the need for water quality management standards for home hemodialysis.