【Objective】Diabetic dialysis patients underwent continuous glucose monitoring, and their blood glucose level changes, quality of life (QOL) scores, complications, and the correlations between the results obtained via flash glucose monitoring (FGM) and self-monitoring of blood glucose (SMBG) were investigated. 【Methods】Flash glucose monitors were attached to diabetic dialysis patients examined at our clinic, and continuous glucose monitoring was performed for 2 months. The subjects also performed SMBG, and the number of measurements; blood glucose, glycated hemoglobin (HbA1c), and glycated albumin (GA) levels; QOL, as evaluated using a diabetes questionnaire (diabetes therapy-related QOL [DTR-QOL]); complications; and the correlations between the results obtained via FGM and SMBG were investigated. 【Results】Seven patients were enrolled (3 females, mean age: 62.4±6.0 years). The mean installation period was 53.0±5.2 days, and the mean number of scans was 7.4±2.6/day. During the study period, the mean SMBG-derived blood glucose level and mean HbA1c level decreased from 215.8±105.2 mg/dL to 212.4±96.9 mg/dL (p=0.48) and from 8.1±0.87% to 8.0±0.93% (p=0.58), respectively, and the mean DTR-QOL score and mean number of SMBG measurements increased from 35.1±19.5 to 42.1±23.0 (p=0.45) and from 3.2±1.2/day to 3.5±1.2/day (p=0.63), respectively. The mean GA level tended to decrease from 31.9±5.8% to 30.0±6.6% (p=0.05). The mean final blood glucose level obtained with FGM was 28.5 mg/dL lower than that obtained with SMBG (−13.4%, 212.4±96.9 mg/dL vs. 183.9±83.1 mg/dL, p<0.0001). The accuracy of FGM exhibited a strong positive correlation with that of SMBG (r=0.91, p<0.0001), but this was not true at lower SMBG-derived glucose levels (<72 mg/dL: r=0.25, p=0.20; 72-180 mg/dL: r=0.63, p<0.0001; >180 mg/dL: r=0.85, p<0.0001). Local reactions were the only complications, and no interruptions occurred. 【Conclusion】FGM can be used in diabetic dialysis patients without serious complications, and the results it produces are correlated with those produced by SMBG.

【Background】The Clinical Practice Guidelines for the Management of Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBD) 2012 recommend the use of cinacalcet hydrochloride, a calcimimetic, in hemodialysis patients with high parathyroid hormone (PTH) levels and normal or high serum phosphorus or calcium levels. Etelcalcetide, a new calcimimetic, is administered intravenously and can be eliminated by dialysis. Here, we investigated the characteristics of etelcalcetide in CKD-MBD patients. 【Methods】The subjects were hemodialysis outpatients with high PTH levels and high or normal serum phosphorus or calcium levels (≥8.4 mg/dL) who were being treated at our hospital. Etelcalcetide was administered to 50 patients. The endpoints were the corrected serum calcium level and the serum levels of phosphorus, intact PTH, tartrate-resistant acid phosphatase (TRACP)-5b, and bone-type alkaline phosphatase. The mean corrected serum calcium level and the serum levels of phosphorus and intact PTH at 24 weeks before the start of etelcalcetide treatment (pre-treatment values) were compared with those at 24 weeks after the start of treatment (post-treatment values). The endpoints were also compared among three treatment groups: the cinacalcet hydrochloride-free group (not treated with cinacalcet hydrochloride), low-dose cinacalcet hydrochloride/etelcalcetide group (switched from ≤25 mg/day cinacalcet hydrochloride to etelcalcetide), and high-dose cinacalcet hydrochloride/etelcalcetide group (switched from ≥26 mg/day cinacalcet hydrochloride to etelcalcetide). 【Results】The mean corrected serum calcium level and serum intact PTH level were significantly lower after treatment (p<0.01). In the low-dose cinacalcet hydrochloride/etelcalcetide group, the mean corrected serum calcium level (p<0.01) and serum intact PTH level (p<0.01) were significantly lower after treatment. No significant findings were obtained in the high-dose cinacalcet hydrochloride/etelcalcetide group. The intact PTH level tended to increase after treatment, although the difference was not significant. The mean etelcalcetide dose increased during the study period due to changes in the TRACP-5b level, and the estimated initial etelcalcetide dose was equivalent to 26-50 mg of cinacalcet hydrochloride. 【Conclusion】Our findings suggest that etelcalcetide might be an effective alternative treatment for secondary hyperparathyroidism when administered at an equivalent dose to cinacalcet hydrochloride.

Previous studies have shown that trivalent iron promoted the growth of Lactobacillus and Bifidobacteria, which enhanced the absorption of iron from the intestines. In our study, 4 hemodialysis patients were given an oral Lactobacillus preparation; i.e., BIO-THREE^® OD tablets, at a dose of 2 tablets 3 times a day, and the effects of the resultant changes in the intestinal microbiota on iron metabolism and anemia-related indices were examined. An analysis of the changes in the intestinal microbiota revealed that in patients 1, 2, and 3 the frequency of the Firmicutes phylum was increased after BIO-THREE^® OD tablets had been orally administered for one month. An examination of the effects of these changes on iron metabolism showed elevated transferrin saturation levels in patients 1, 2, and 4 after BIO-THREE^® tablets had been orally administered for one month. In addition, patients 1 and 4 exhibited decreased serum levels of hepcidin-25 after the BIO-THREE^® OD tablets had been orally administered for 3 months. The analysis of anemia-related indices showed that the oral administration of BIO-THREE^® OD tablets had little effect on hemoglobin levels. Although the patients who displayed changes in their intestinal microbiota did not overlap with those who showed changes in iron metabolism, our findings suggested that the oral administration of BIO-THREE^® OD tablets promoted the ferric-reducing effects of intestinal bacteria and enhanced iron absorption.

【Aim】To investigate the differences between sodium (Na), potassium (K), and chloride (Cl) measurements obtained via blood gas analysis (BGA) and laboratory biochemical tests (BT). 【Method】Forty-one hemodialysis patients were subjected to BGA using the RAPID Lab 1200 (SIEMENS) and BT using the TBA-120FR automatic analyzer.【Results】The following Na, K, and Cl measurements were obtained via BT and BGA: Na: 138.3±3.4 and 137.0±3.5, K: 4.67±0.71 and 4.47±0.7, and Cl: 105.6±3.3 and 107.5±3.3 mEq/L, respectively. Thus, BGA produced lower Na and K measurements and higher Cl measurements than BT (p<0.0001). The difference between the Na (⊿Na) levels obtained using the two methods was significantly correlated with the total protein (TP) level (p=0.0002). The ⊿Na was greater at low TP levels. The ⊿Cl was greater when the HCO₃ level was low (p=0.013).【Discussion】Electrolyte levels are measured using ion-selective electrodes (ISE), and indirect and direct methods are used for BT and BGA, respectively. As the electrolyte measurement standard solution contains a “normal” amount of protein, ⊿Na increases when the TP level is low. Chloride ion-selective electrodes are affected by anions in the standard solution. As specimens subjected to indirect methods contain less HCO₃ than those subjected to direct methods, Cl measurements obtained via BGA are affected more by HCO₃ than those obtained via BT.【Conclusion】Differences in electrolyte level measurements can occur between BT and BGA because BT involve serum being subjected to indirect ISE-based methods, whereas BGA involves whole blood being subjected to direct methods.

We encountered a case of ethylene glycol poisoning that could be managed by early administration of fomepizole and blood purification therapy. In addition, quick provision of information on the use of fomepizole for ethylene glycol poisoning and prompt supply of fomepizole was effective.

A 76-year-old male hemodialysis patient underwent radiotherapy for glottis carcinoma two years ago. Follow-up positron emission tomography-computed tomography detected a right-sided renal mass, renal hilar lymph node swelling, and ¹⁸F-fluorodeoxyglucose accumulation in the bilateral inguinal regions. He underwent right renal nephrectomy with lymphadenectomy. The pathological diagnosis was malignant lymphoma (non-Hodgkin’s lymphoma, follicular lymphoma, grade 1). He did not receive postoperative chemotherapy, but no further objective target lesions were detected. At 10 postoperative months, he was doing well and recurrence-free. This is only the third reported case of primary renal malignant lymphoma involving a hemodialysis patient in Japan.