A survey of 4,123 facilities was conducted to investigate the use of the Miawase approach to dialysis, and responses were received from 1,201 facilities. Approximately 40％ of the facilities did not have a system for implementing advance care planning (ACP) or shared decision-making (SDM). The mortality rate due to dialysis discontinuation was 5％, and the non-compliance rate with “Shared decision making for the initiation and continuation of dialysis：a proposal from the Japanese Society for Dialysis Therapy” was 18％. When SDM was fully implemented, the consensus rate for all parties involved in cases with decision-making capacity and not in the terminal stages of life was 96％. The selection criteria for the statistical survey cause-of-death items “refusal of treatment (refusal of dialysis)” and “the Miawase approach to treatment” as well as death resulting from use of the Miawase approach to dialysis at the terminal stage of a complication (either “Miawase approach to treatment” only, “complication name” only, or one of these per case) differed among facilities. It is necessary to develop a system for implementing ACP and SDM in order to comply with the new proposal and to revise cause-of-death items in statistical surveys of the Miawase approach to dialysis in order to accurately determine the number of deaths associated with this method.

The number of medical manuscripts has increased rapidly since 2000, resulting in a flood of medical information. It is important that humans are able to select appropriate information from this information flood. Here, we text-mined and analyzed the abstracts of original articles and case reports about “hemodialysis” in the Japan Medical Abstracts Society database. We analyzed 26,408 original articles and 8,936 case reports about "hemodialysis", which were published from 1979 to 2020. The total number of words extracted from the abstracts was 1,637,446 for the original articles and 562,949 words for the case reports. There were many studies that examined the extracorporeal circulation method, efficiency, biocompatibility, etc., which were often found during the analysis of the original articles. Furthermore, there were many case reports about treatment difficulties in clinical practice. This study demonstrated that it was possible to analyze the hemodialysis-related case reports included in the Japan Medical Abstracts Society database using the text-mining method and to grasp the changes in clinical hemodialysis treatment that occurred during the study period.

[Objectives] This study aimed to investigate the feasibility, efficacy, and long-term patency rate of endovascular declotting of thrombosed native arteriovenous fistulas under duplex imaging. [Methods] In 2019 and 2020, 141 cases of acutely occluded native arteriovenous fistulas were treated with endovascular declotting by one surgeon at Nagoya Vascular Surgery Clinic. Most cases were treated with thromboaspiration via a 4 – 8 Fr sheath followed by percutaneous transluminal angioplasty (PTA). All procedures were carried out under selective cutaneous nerve blocks, with duplex ultrasonography used as the sole imaging modality. The technical success rate and patency rate were assessed. Assisted primary patency was defined as the period between treatment and any surgical intervention. [Results] The technical success rate was 96.5％. The median operation time was 64 minutes. PTA was performed in 121 (85.8％) cases, thrombolysis with urokinase was performed in 15 (11％) cases, and endovascular forceps were used in 29 (20.6％) cases. There were 9 complications, of which two resulted in procedure failure and immediate conversion to open surgery. The median duration of the follow-up period was 17.3 months. The primary patency rate was 41.8％ at 6 months and 28.6％ at 1 year. The assisted primary patency rate was 87.0％ at 1 year and 85.6％ at 2 years. [Conclusions] Although the primary patency rate was low, the good results regarding the technical success rate and assisted primary patency rate encourage the aggressive application of endovascular treatment for acutely occluded native arteriovenous fistulas.

Dialysis patients that have been infected with the hepatitis C virus (HCV) have a worse prognosis than uninfected patients. Thus, the prevention, diagnosis, and treatment of HCV infections are important issues in dialysis. In 2020, we conducted a survey on the current status of HCV infections, testing, and treatment among dialysis patients at hemodialysis facilities in Chiba. Of the study subjects, 3.7％ were positive for HCV antibodies, and 1.7％ were HCV-RNA-positive, which are lower than the rates seen in the 2018 national survey (5.2％ and 2.5％, respectively). Forty-one percent of patients were referred to a hepatologist, higher than the percentage seen in the 2018 national survey (22.8％). Antiviral therapy was given to 24％ of HCV antibody-positive patients, of whom 71％ were treated with direct-acting antivirals. Furthermore, 7.5％ of the HCV antibody-positive patients had been treated for hepatocellular carcinoma in the past five years. Compared with the national survey results, there is a high level of concern about HCV infection, testing, and treatment in Chiba. However, greater disease awareness and more treatment and testing are required.

We measured anti-SP-IgG antibody titers 6 months after the second dose of a SARS-CoV-2 vaccine (BNT162b2) and 1 month after the third vaccination in 105 hemodialysis patients, and examined the booster effect of the third vaccination. The mean anti-SP-IgG antibody titer at 6 months after the second vaccination was 499.2±619.4 AU/mL, which was about one-tenth lower than that seen 1 month after the second vaccination；however, 7 patients exhibited negative conversion (＜50 AU/mL). The mean anti-SP-IgG antibody titer at 1 month after the third vaccination, including the cases involving negative conversion, had increased 85.7 times to 42,800.9±58,666.2 AU/mL, confirming the booster effect of the third vaccination. However, although the causes were unknown, there were two unresponsive cases.

A 76-year-old male underwent left nephrectomy for left renal cell carcinoma in July X-3. In July X-2, metastasis to the left crus of the diaphragm was confirmed. He was treated with pazopanib and axitinib, but the disease progressed. He was treated with heavy particle irradiation. However, in February X metastasis was detected in the upper lobe of the right lung, and he was started on nivolumab. Before the start of the nivolumab treatment, he had a serum creatinine level (S-Cr) of 1.52 mg/dL, and urinary tests produced the following results：urinary protein (–) and urinary occult blood (–). He received 240 mg nivolumab every 2 weeks for a total of 4 doses. After that, his S-Cr increased to 3.6 mg/dL. He was referred to our department and admitted in June X. On the 8th day, a renal biopsy was performed. Crescentic glomerulonephritis and acute tubulointerstitial nephritis were diagnosed. Steroid therapy was started on the 12th day. Although he needed hemodialysis for 2 weeks, he achieved a partial renal recovery. As crescentic glomerulonephritis caused by immune checkpoint inhibitors is rare, further case accumulation is needed.