［Introduction］We evaluated the efficacy of lubiprostone and linaclotide against chronic constipation in hemodialysis（HD）patients at a long‒term care hospital.［Subjects］Twenty‒five HD patients with chronic constipation were enrolled in this study.［Methods］The patients were prescribed sennoside for 1 month. At the start of the study, the sennoside was changed to lubiprostone. After 1 month, lubiprostone was changed to sennoside once again. Then, 1 month later, the sennoside was changed to linaclotide.［Results］The non‒diabetic kidney disease group exhibited significantly lower serum inorganic phosphorus levels after 1 month’s lubiprostone therapy than at the initiation of the treatment. In addition, their Constipation Scoring System scores were significantly lower after 1 month’s linaclotide therapy than at the initiation of the treatment. However, in the diabetic kidney disease group, neither lubiprostone nor linaclotide caused any improvements.［Conclusion］It is postulated that lubiprostone and linaclotide are useful treatments for chronic constipation in HD patients with non‒diabetic kidney disease at long‒term care hospitals.
The unplanned initiation of hemodialysis is a prognostic risk factor for survival in maintenance hemodialysis patients. We examined the nutritional challenges associated with the unplanned initiation of hemodialysis. The study subjects comprised patients who were started on maintenance hemodialysis within 1 year from April 2017. The planned initiation group included patients who had a vascular access point before their admission and were considered to have undergone a scheduled admission. The remaining patients were included in the unplanned group. We compared the two groups and retrospectively collected information on primary disease, age, length of hospitalization, complications, outcomes, nutritional management, nutrition support team activity, the rehabilitation intervention rate, blood test results, and activities of daily living（ADL）. Eighty‒one patients were included in this study. Among them, the unplanned initiation group comprised 26 patients（32％）（median［IQR］age： 76（70‒82）years）. The median length of hospitalization was 48（32‒64）days. Forty‒six percent and 77％ of patients were complicated by heart failure and infectious diseases, respectively. The unplanned initiation group had significantly more difficulties, according to the results of the nutritional status assessment, and lower serum albumin levels than the planned initiation group; however, they exhibited better dietary intake. In addition, the unplanned initiation group exhibited poor nutritional index values and ADL recovery and a high hospital transfer rate. Our findings suggest that among patients subjected to the unplanned initiation of hemodialysis nutritional status and poor ADL recovery at the initiation of maintenance hemodialysis might be related to a poor prognosis.
Increasing numbers of patients are having difficulty travelling to dialysis facilities due to problems performing activities of daily living. We performed a survey of the transportation patients use to visit dialysis facilities in Aichi Prefecture. We collected questionnaires from most dialysis facilities（178/184 facilities）and obtained data for 17,680 patients. There were 7,348 patients（42％）who needed to be picked up/dropped off using cars owned by dialysis facilities, and 7,071 patients travelled to dialysis facilities in cars they owned. Among patients aged ≤70 years old, more patients used their own cars than used cars owned by dialysis facilities. Patients that lived with their families mainly used their own cars to visit dialysis facilities（46.7％）, followed by cars owned by the facilities（41.5％）. However, patients who lived alone were mainly transported to dialysis facilities in cars the facilities owned（45.6％）. In conclusion, a large proportion of the dialysis patients in Aichi Prefecture used cars owned by dialysis facilities to visit such facilities. Age and residential status might influence the transportation patients use to visit such facilities.
The ankle‒brachial systolic pressure index（ABI）and skin perfusion pressure（SPP）are widely used as diagnostic tools for peripheral arterial disease（PAD）. Although several studies have suggested that higher cut‒off values are needed to detect early‒stage atherosclerosis, which causes PAD, no consensus about this has been reached. In Doppler pulse studies, the loss of reverse diastolic flow indicates the presence of stenosis of ≥20％. Thus, lower limb ultrasonography is considered to be a more useful tool for detecting the early stages of PAD than ABI or SPP. As vascular ultrasound procedures are complicated, we tested the usefulness of Doppler waveform analysis that was restricted to the anterior and posterior tibial arteries. Twenty‒two patients that had been started on hemodialysis within the last year were investigated. Seven out of 11 patients with abnormal Doppler patterns showed no ABI or SPP abnormalities. These results suggest that Doppler waveform analysis can detect early arteriosclerotic changes that cannot be identified using ABI or SPP.
Here, we report a case in which refractory mandibular osteomyelitis was successfully managed with continuous local antibiotic perfusion（CLAP）. A 66‒year‒old male, who had been started on maintenance hemodialysis 20 years ago, was admitted to hospital for a high fever and chills 18 days after the extraction of dental caries. Although he received antibiotic therapy for 3 days in the hospital, his general condition did not improve. He was transferred to our university hospital and underwent emergency drainage of an abscess from the left lower jaw to left temporal head. However, contrast‒enhanced CT（performed on day 53）showed mandibular sequestration. As his general condition and comorbidities precluded surgical interventions, we decided to apply CLAP. After 2 weeks’ CLAP without any adverse events, his general condition improved, and he was transferred to a rehabilitation hospital. Five months later, the infection had not relapsed. In addition, his mandible had recovered from the sequestration. This case report indicates that CLAP is a promising procedure for bone and soft tissue infections in maintenance hemodialysis patients.
An 88‒year‒old female, who had been treated with hepatic artery chemoembolization for hepatocellular carcinoma associated with hepatitis C four years ago, was admitted to our hospital because of chronic kidney failure, accelerated hypertension, orthopnea, and severe generalized edema. Her serum Cr value was 6.43 mg/dL, and her plasma noradrenaline value was 1,173 pg/mL. A CT scan revealed a right‒sided adrenal mass, an atrophic right kidney, and marked pleural and pericardial effusion. Echocardiography showed cardiac tamponade with a preserved left ventricular ejection fraction. Hemodialysis was started, but did not ameliorate the patient’s hypertension or pericardial effusion. As hypothyroidism was detected（TSH level：＞100 μIU/mL）, thyroxine was administered in addition to the hemodialysis. After that, the amount of pericardial effusion decreased, the patient became normotensive, and her plasma noradrenaline level normalized（to 205 pg/mL）. Hypothyroidism needs to be considered as a cause of pericardial fluid retention when dialysis treatment is initiated.