To determine the phosphorus content of processed meat products, we analyzed 14 brands of Vienna sausages and 10 other processed meat products using vanadomolybdate absorptiometry. In addition, to clarify the changes in the phosphorus content of processed meat products induced by cooking, we cooked Vienna sausages using four different methods. The phosphorus contents of the 14 brands of Vienna sausages ranged from 118.3 to 344.0 mg, and their phosphorus‒to‒protein ratios ranged from 7.4 to 32.8 mg/g. The phosphorus contents and phosphorus‒to‒protein ratios of the 10 other processed meat products ranged from 84.9 to 356.4 mg and from 6.5 to 21.6 mg/g, respectively. Products that did not contain phosphorus or PH‒control agents (according to their labels) had lower phosphorus contents. Making shallow cuts in the products and boiling them significantly reduced their phosphorus contents (27.0％；p＝0.008). In general, the phosphorus contents of processed meat products vary among brands. To restrict dietary phosphorus intake, we recommend consuming processed meat products that do not contain phosphorus or PH‒control agents. Furthermore, it is recommended that processed meat products should be boiled in order to reduce their phosphorus contents.

［Aims］This study examined the burden placed on the primary caregivers of elderly individuals undergoing peritoneal dialysis (PD) therapy and the factors associated with this burden.［Methods］A self‒administered questionnaire was completed by 152 primary caregivers of elderly patients undergoing PD therapy. The questionnaires were distributed at six study centers； i.e., hospitals in the Kyushu, Chugoku, and Kanto regions. Valid responses were obtained from 96 primary caregivers and were included in the analysis. The analysis was performed using Quantification theory Type I, with the characteristics of caregivers and care recipients, and care conditions used as the explanatory variables and the caregivers’ sense of burden employed as the criterion variable.［Results］Being awakened at night for caregiving, difficulty in performing domestic or professional work due to caregiving related to PD, not being able to talk to friends or acquaintances about problems, the primary caregiver being in poor health, and the care recipient requiring assistance with activities of daily living were significantly associated with caregivers’ sense of burden. Actively allocating social resources after taking into consideration the physical aspects and lifestyle of the primary caregiver and reinforcing informal support are important for reducing the sense of burden associated with caregiving.

The number of elderly dialysis patients is increasing rapidly, which presents significant challenges relating to the diagnosis and treatment of sarcopenia. However, no easily applicable measure of sarcopenia for use in the clinical setting currently exists, and the specialized equipment used to diagnose sarcopenia in clinical practice； i.e., dual energy x‒ray absorptiometry or bioelectrical impedance analysis (BIA), has some significant limitations. The Ishii score (IS), which is based on three easily obtainable variables, age, grip strength, and calf circumference, has been developed, and it has been demonstrated that sarcopenia can be detected in older adults with high accuracy based on the IS. The purpose of this study was to investigate whether the IS has validity as a diagnostic screening tool for sarcopenia in hemodialysis (HD) patients. Two cohorts of maintenance HD patients, 82 at N clinic and 28 at O hospital, were studied. The calculation of the IS, anthropometric measurements, and BIA were performed after HD treatment. The patients with suspected sarcopenia； i.e., those with IS of ＞160, were significantly older and had significantly lower mean arm circumference, calf circumference, and serum albumin values than the patients that were not suspected to have sarcopenia (P＜0.05). The subjects at N clinic consisted of patients who did not require assistance with hospital visits (group A, 22％), patients who needed assistance with walking (group B, 58.5％), and wheelchair users (group C, 22％). Group C had significantly higher IS than groups A and B (P＜0.001). The IS was significantly inversely correlated with the serum level of creatinine, a muscle metabolite (r＝－0.795, P＜0.001), and was also significantly inversely correlated with the skeletal muscle index according to BIA (r＝－0.805, P＜0.001). In conclusion, IS is a useful diagnostic screening tool for detecting sarcopenia in HD patients in clinical practice.

Of the 110 patients who had undergone outpatient maintenance hemodialysis and 16 staff members at our facility, 3 patients and 3 nurses were diagnosed with COVID‒19 based on RT‒PCR tests for SARS‒CoV‒2 between April 1st and April 8th, 2020. Three elderly male patients presented with a cough and a fever, 2 of whom had diabetes mellitus with pseudobulbar palsy due to cerebral infarctions and were taking corticosteroids for pemphigoid. Two nurses developed fevers. After the outbreak of COVID‒19, all patients and staff members were screened for COVID‒19 using RT‒PCR, and one asymptomatic nurse was found to be positive for the disease. Three patients and one nurse were hospitalized, and the remaining 2 nurses remained at home. All of them recovered from COVID‒19. In July 2020, all of the patients and staff members, except for the 5 (excluding one in hospital) with a history of the disease, were negative for antibodies against SARS‒CoV‒2. Since then (until October 10th, 2020), we have not experienced any new cases of COVID‒19.

A 76‒year‒old male, who had end‒stage renal failure caused by contrast‒induced nephropathy, was admitted to our hospital due to congestive heart failure, after complaining of dyspnea. An arteriovenous fistula was created in his left arm. Emergent hemodialysis was performed with a central venous catheter. On the 4th hospital day, the patient fainted and convulsed for a few minutes during hemodialysis. Magnetic resonance angiography failed to visualize the basilar artery. Subclavian angiography showed occlusion of the origin of the right vertebral artery and severe ostial stenosis of the left vertebral artery. The patient was diagnosed with vertebrobasilar insufficiency (VBI). After percutaneous transluminal angioplasty and stenting for ostial stenosis of the left vertebral artery, angiography showed no further evidence of stenosis, and the patient did not faint again. It is extremely rare for VBI to occur during the initiation of dialysis.

A 55‒year‒old male with end‒stage renal disease due to IgA nephropathy was initially admitted to undergo peritoneal dialysis (PD) on December Y, 201X. On the 3rd day of hospitalization, a peritoneal catheter was inserted, and continuous ambulatory PD was started. On the 8th day of hospitalization, the patient experienced genital swelling after the peritoneal dialysate volume was increased. Careful examination revealed a left‒sided communicating hydrocele. After the suspension of the PD, an operation to repair an inguinal hernia was performed. PD was resumed 8 days after the operation without recurrence. Communicating hydroceles associated with PD have been reported in some cases. However, there are no definitive diagnostic criteria or treatments for such cases. It is necessary that further cases should be investigated.

In X－19, a 74‒year‒old male with end‒stage kidney disease caused by IgA nephropathy was started on continuous ambulatory peritoneal dialysis. In X－13, he was switched to hemodialysis due to fluid retention. In X－2, he underwent mitral valve replacement surgery because he experienced difficulties with dialysis caused by the exacerbation of mitral regurgitation and loss of cardiac function. In X－1, marked ascites appeared. In X, he was admitted to our hospital because of severe pleural effusion, ascites, anemia, and weight loss. He died of respiratory failure, and an autopsy was performed. His intestines were covered by a thick peritoneum： therefore, he was diagnosed with encapsulating peritoneal sclerosis.

We experienced three cases in which hemodialysis patients developed COVID‒19. Case 1 involved a 77‒year‒old female. Nine days before admission, she developed a fever after coming into contact with a COVID‒19 patient. She was treated with steroids and favipiravir, but her respiratory condition worsened on the 6th day of hospitalization. She was released from infection control on the 18th day of hospitalization and was transferred to another hospital on the 28th day of hospitalization. Case 2 involved an 85‒year‒old male. He developed a fever 2 days before admission after having close contact with a COVID‒19 patient. Antibiotic treatment was started, but his respiratory condition worsened on the 6th day of hospitalization, and steroid treatment was initiated. He was released from infection control on the 20th day of hospitalization and was transferred to another hospital on the 46th day of hospitalization. Case 3 involved an 87‒year‒old male. He was admitted with respiratory failure due to pneumonia. Treatment with antibiotics, steroids, and remdesivir was started, but his respiratory condition worsened on the second day of hospitalization, and he died on the 12th day of hospitalization. We reported three cases in which the respiratory status of hemodialysis patients worsened during treatment for COVID‒19.