Since hemodialysis catheter placement has been reported to carry a high risk of serious complications, safer ultrasound-guided procedures are required. In this study, we examined the factors affecting the ultrasonic visibility of the short-axis of the puncture needle tip using a simulator. There was no significant difference in needle tip visibility between metal needles of the same gauge with bevel angles of 12° and 18°, but tip visibility was significantly higher at a transmission frequency of 8MHz than at a transmission frequency of 13MHz at both bevel angles. There was no significant difference in needle tip visibility between a 20-gauge needle and a 23-gauge needle with the same bevel angle, but needle tip visibility was significantly higher at 8MHz than at 13MHz at both gauges. In an examination of bevel orientation, needle tip visibility was significantly reduced when the bevel opening was rotated 45° or 90° compared with when the bevel opening was directly facing the ultrasound beam. The use of a lower transmission frequency of <10MHz and ensuring that the puncture needle bevel directly faces the ultrasound probe have the potential to improve needle tip visibility during short-axis ultrasound-guided central vein puncture.
This prospective crossover study aimed to evaluate the efficacy of ozonated water for shunt washing, compared with invert soap and alcohol. Seventeen hemodialysis (HD) patients were enrolled. We assessed transient cleanliness levels, based on the levels of ATP＋ADP＋AMP, during HD (before washing; at the start of the HD; and at 2 hr, 4 hr, and 6 hr after the start of the HD) in patients that were washed with ozonated water, invert soap, or alcohol. Moreover, to study shunt limb roughening we graded the shunt limbs after each washing method (grades 1 to 5; 1: not rough, 5: severely rough). In each group, the ATP＋ADP＋AMP level was significantly decreased after washing (ozonated water group: 2,816 to 515 RLU, p=0.0354; invert soap group: 2,140 to 306 RLU, p=0.0414; alcohol group: 2,924 to 431 RLU, p=0.0113), and the final RLU value was below the hand hygiene management standard (2,000 RLU). The scores for the degree of shunt limb roughening were 1.06±0.24, 1.24±0.44, and 1.41±0.50 in the ozonated water, invert soap, and alcohol group, respectively. The ozonated water group exhibited significantly less shunt limb roughening than the alcohol group (p=0.0411). Washing shunt limbs with ozonated water is as effective as washing them with soap or alcohol throughout HD. From the viewpoint of skin care, ozonated water is an invaluable substance for cleaning shunt limbs.
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection rates have been reported to be higher in patients receiving hemodialysis (HD) treatment than in the general population. Eighty-two outpatients used the dialysis facilities at Ehime Prefectural Central Hospital from 2016-2018. Of these, 31 (37.8%) patients tested positive for anti-hepatitis B surface antigen and/or anti-hepatitis B core antigen (HBc) antibodies, including 6 patients who tested positive for anti-HBc antibodies alone. The 31 patients all tested negative for HBV-DNA. Eight (9.7%) patients tested positive for anti-HCV antibodies, 6 of whom tested positive for HCV-RNA. Among the HCV-RNA-positive patients, 4 were positive for genotype 1, and 2 were positive for genotype 2. Five of these patients received direct-acting antivirals. All 5 patients exhibited sustained virological responses at 24 weeks after treatment (SVR24) Creating a portable flowchart can help raise awareness of infection countermeasures.
Higher serum magnesium (Mg) levels are reported to be associated with better prognoses in dialysis patients. Regarding Mg supplementation, we studied the Mg contents of 100 foods that are often consumed in daily life and the amount of Mg per ordinary serving values of these foods. In the standard diet for dialysis patients (1,800kcal, 60g protein), meals in which plant-derived protein accounted for 60% of total protein had higher Mg contents than those with plant-derived protein percentages of 50% and 40% (358±47, 309±36, and 254±28, respectively; p<0.001). Furthermore, there were no significant differences in the amounts of phosphorus or potassium among these meals, and the amino acid score was 100 (perfect). Therefore, to increase the Mg intake of dialysis patients it would be advantageous to ensure that plant-derived proteins account for 60% of total dietary protein.
This case involved an 89-year-old male with chronic renal failure due to nephrosclerosis, who had been on hemodialysis for 19 years. He was diagnosed with prostate cancer at the age of 75 and was treated with a gonadotropin-releasing hormone agonist. As his prostate cancer became medical castration-resistant, 5mg/day prednisolone was administered concomitantly with the CYP17 inhibitor abiraterone acetate (AA). Six months later, he became hypotensive independent of dialysis, and his symptoms persisted despite his target weight increasing. Blood endocrine tests showed a low level of cortisol, a high level of ACTH, and a normal upper limit level of aldosterone. His hypotension improved rapidly after the short-term administration of hydrocortisone. Based on an interview with the patient, it was suspected that the adrenocortical insufficiency had been caused by the patient forgetting to take prednisolone under AA treatment. Therefore, the AA was discontinued first, and then the prednisolone was gradually tapered and discontinued. After the patient’s medication was stopped, his serum cortisol level was maintained with the standard range, and hemodialysis proceeded smoothly without hypotensive symptoms.