[Background and Purpose] On vascular access-related ultrasound examinations, stenosis is generally evaluated by measuring the inner diameter of the target blood vessel on the long-axis cross-section (stenotic diameter), but accurate evaluations are difficult if the lumen does not form a perfect circle on the short-axis section. In this study, we compared stenotic diameter and cross-sectional area data obtained during such examinations. [Methods] This study included 83 patients (a total of 129 lesions) with arteriovenous fistulas. Stenotic diameter on the long-axis cross-section and the long and short diameter and cross-sectional area of the lesion on the short-axis cross-section were measured. ROC analysis was used to compare the utility of stenotic diameter and cross-sectional area for diagnosing vascular access failure. We classified stenosis into 5 types and examined the correlation between stenotic diameter and cross-sectional area. [Results] ROC analysis showed that there were no differences in diagnostic utility between stenotic diameter and cross-sectional area. The correlation between stenotic diameter and cross-sectional area was good, except in cases of aneurysmal-type stenosis. [Conclusion] Evaluations based on stenotic diameter are diagnostically useful, except in cases of aneurysmal-type stenosis. Aneurysmal-type stenosis can be evaluated based on the cross-sectional area of the lesion.

At present, VAIVT (vascular access intervention therapy), in which a balloon is used to achieve vasodilation, is widely performed for vascular stenosis that occurs in arteriovenous fistulas or arteriovenous grafts in hemodialysis patients. When the balloon cannot be fully expanded at the stenotic lesion during VAIVT, the so-called dog bone change is observed, which might result in incomplete dilation of the lesion and residual stenosis. In this study, we experimentally examined the lesion dynamics at dilation sites for dog bone changes, and whether the blood vessels at the dilation site and in the surrounding tissues gathered together at the time of the balloon dilation, resulting in resistance to balloon dilation. We confirmed that such changes occurred, which we named the lesion-slip phenomenon. In clinical studies, it was suggested that the lesion-slip phenomenon might require dilation to be performed at a higher pressure or might cause vascular dissection or the development of new lesions in the depopulated peripheral areas as a result of the concentration of tissues. The angioplasty vasodilator balloon, which has an inhibitory effect on the lesion-slip phenomenon, might allow the complete dilation of lesion sites at a lower pressure and reduce the risk of vascular injuries.

The annual survey of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) conducted in December 2018 reported that since 2015 the number of incident dialysis patients has tended to increase. Population aging has significantly affected the number of incident dialysis patients. Therefore, to clarify the trends over time in primary disease among incident dialysis patients and the characteristics of incident dialysis patients aged≥80 years, we examined the number of incident dialysis patients and the frequency of each primary disease in 3 age groups using data obtained from the annual survey of the JRDR over the past 7 years (CD-ROM version). As a result, we found that among patients aged≥20 years to<80 years, the primary disease rate and associated incident dialysis rate of diabetic nephropathy and chronic glomerulonephritis decreased, whereas those of nephrosclerosis and unknown primary diseases increased. The rates of all other primary diseases remained the same. It was considered that the increase in the number of incident dialysis patients was mainly because of an increase in the elderly (aged≥80 years) population, and that certain primary diseases were associated with the increase in the incident dialysis rate among patients aged≥80 years. In future, measures aimed at elderly patients will become much more important for reducing the incident dialysis rate.

Although the prognosis of patients infected with the human immunodeficiency virus (HIV) has improved markedly due to advances in treatment, the number of HIV-infected patients that require dialysis is rising due to aging and the increasing prevalence of complications. Therefore, there is an urgent need for hemodialysis clinics to accept HIV-infected patients. However, many dialysis facilities are reluctant to accept such patients, mainly due to anxiety caused by a lack of understanding about HIV infections. We established a special measures team, which implemented active study sessions for our staff regarding the acceptance of HIV-infected patients. A pre-study survey of the dialysis staff revealed that 85.2% of them agreed with the following statement: “I feel anxious about contact with HIV-positive dialysis patients”, and 25.9% of them responded, “We should not accept patients who are HIV-positive”. However, these rates decreased to 48.1% and 7.4%, respectively, after the study sessions. Educating staff about HIV infections is an important way for hemodialysis clinics to increase their acceptance of HIV-infected patients.

We encountered a case of minocycline hydrochloride-induced skin pigmentation in a hemodialysis patient. The patient had been on hemodialysis for chronic renal failure due to nephrosclerosis for one year. He was diagnosed with pyogenic spondylitis 7 months before his admission and was started on 200 mg/day oral minocycline. Two months before admission, black spots appeared on his extremities, which were considered to be due to subcutaneous bleeding. Thereafter, he was admitted to our hospital because of difficulty piercing the shunt vessel. Large areas of his limbs were covered with black spots with unclear boundaries. As he was receiving long-term oral minocycline hydrochloride treatment, the cause of the spots was suspected to be drug-induced cutaneous pigmentation. He was subsequently pathologically diagnosed with drug-induced skin pigmentation. Hemodialysis patients often develop subcutaneous hemorrhages due to platelet dysfunction, the effects of drugs, or frequent vascular puncture procedures. Therefore, when skin pigmentation is observed in a dialysis patient it is necessary to distinguish it from subcutaneous hemorrhaging.

The patient, a 55-year-old, was started on hemodialysis at the age of 51, after undergoing nephrectomy for a right renal tumor. She started taking oral alfacalcidol after 2 months of hemodialysis. After undergoing hemodialysis for 4 years, she was hospitalized for a subcutaneous lumbar mass and hypercalcemia, which persisted after the discontinuation of alfacalcidol. Sarcoidosis was diagnosed based on her high serum lysozyme level, the abnormal accumulation exhibited by the mass on gallium scintigraphy, and the fact that a biopsy of the mass revealed that it was a non-caseating epithelioid granuloma. Steroid treatment improved the hypercalcemia and subcutaneous mass. It was suggested that the sarcoidosis had been present for a while because pathologically both a previous brain tumor and the renal tumor were epithelioid granulomas. Furthermore, active vitamin D has been reported to promote the formation of epithelioid granulomas and to affect the pathogenesis of sarcoidosis. It is suggested that the sarcoidosis in this case might have been related to the administration of an active vitamin D preparation.