To improve the quality of life (QoL) of patients on chronic dialysis therapy, it is crucial to identify the core outcomes for those patients. The present survey aimed to examine the main outcomes that are recognized as crucially important by doctors and patients and to identify the differences between these two groups. A voluntary survey was conducted via mail among doctors (specialists in dialysis therapy) and chronic hemodialysis patients (at outpatient clinics). The respondents were required to make subjective evaluations (on a Likert scale) about the importance of 45 keywords associated with 4 hemodialysis-related dimensions (disease and prevention, dialysis therapy, subjective symptoms, and lifestyle-related). Responses were obtained from 184 doctors (recovery rate: 36.8％) and 898 patients (89.8％). The 20 keywords that were most highly prioritized by each group included 14 items relating to disease and prevention or dialysis therapy, while the remaining 6 items chosen by the patients all related to subjective symptoms (chronic fatigue, being washed out after dialysis) or lifestylerelated issues (travel, impact on family/friends, financial impact, impact on work and employment). Regarding subjective symptoms, the leading item for patients was “being washed out after dialysis”, followed by “chronic fatigue”. Among all the keywords, the largest gap in outcome significance between patients and doctors was seen for “chronic fatigue”, followed by “travel” and “being washed out after dialysis”. Regarding the measures employed for “chronic fatigue” and “being washed out after dialysis”, 19.2％, and 12.1％ of doctors, respectively, responded that these measures were “sufficient”. The core outcomes for dialysis patients were “being washed out after dialysis” and “chronic fatigue”. Conversely, doctors considered these outcomes to be less significant, despite recognizing that the associated countermeasures are insufficient, indicating the presence of clinical inertia. Dialysis therapy-related fatigue needs to be targeted by a multidiscipline approach in order to improve patientsʼ QoL.

We have been conducting a clinical epidemiological study on chronic dialysis patients in Okinawa, Japan. We defined those who survived at least one month on scheduled dialysis or underwent kidney transplantation as chronic dialysis patients (end-stage kidney disease, ESKD). Chronic dialysis treatment was started in June 1971, and there are currently 74 dialysis units. Previously, we reported the demographics of dialysis patients in OKIDS20 (1971-1990) and predictors of survival in OKIDS30 (1971-2000). In OKIDS30, the rate of transfer outside Okinawa was only 1.2％ (N＝61). The 1-, 5-, 10-, and 20-year cumulative survival rates were 88.6％, 66.5％, 48.2％, and 29.3％, respectively. There were 1,982 and 5,246 registered patients in 1990 and 2000, respectively. In OKIDS50, it is expected that there will be around 13,500 registered patients. According to the 2020 annual report from the Japanese Society for Dialysis Therapy, the prevalence of dialysis patients per million population was 3232 in Okinawa and 2754 in Japan, respectively. Among the potential predictors of survival other than sex；age；primary renal disease；and comorbid conditions, such as stroke and acute myocardial infarction, variables related to malnutrition, such as low serum albumin and cholesterol levels, and high serum C-reactive protein levels were found to be significant. We also investigated the predictors of developing ESKD by combining the OKIDS and general screening registries. The most potent predictor of ESKD was dipstick-positive proteinuria；the 10-year cumulative incidence was 10％ and 5％ in patients with dipstick proteinuria scores of ≥3＋ and 2＋, respectively. Other significant predictors were dipstick hematuria, hypertension, obesity, a low hematocrit level (males：＜40％, females：＜35％), and hyperuricemia. Upon completion of the OKIDS50, we will consider the historical changes in the primary renal diseases, incidence, prevalence, and survival of chronic dialysis patients and compare them to the changes in the background population of Okinawa.

[Objectives] This study aimed to evaluate the relationships between the area under the curve (AUC) of monthly serum phosphorus levels (P) of＞4.5 mg/dL for 6 months and the following：monthly averaged P for the 6- month period, one-time P, chest X-ray-evaluated aortic arch calcification (AoAC), and echocardiography results. [Subjects] The subjects were 109 patients who received maintenance hemodialysis (HD) for ≥6 months. [Methods] ①We evaluated the correlation among the AUC, averaged P, and one-time P. ②We divided the HD patients into two groups based on the median AoAC and compared their P, cardiac function, and other factors. ③We grouped the patients into three groups according to their AUC and compared their AoAC, cardiac function, and other factors. [Results] ①The AUC was strongly correlated with the averaged P. ②The AUC and averaged P of the HD patients with higher AoAC values were significantly higher. ③The patients with the highest AUC values had significantly higher AoAC and E/e´ values. [Conclusions] The AoAC values of the HD patients with higher AUC values and averaged P were significantly increased, and their cardiac diastolic functions were decreased. As the P of HD patients fluctuate according to their diet and medication adherence, the AUC, is a more suitable measure than one-time P. However, the averaged P, which is strongly correlated with the AUC, is not inferior to the AUC.

Liver fibrosis (LF) progresses more slowly after the elimination of the hepatitis C virus (HCV) by antiviral therapy. Liver biopsy is the gold standard for evaluating LF；however, it is invasive and can cause procedure-related complications. Therefore, non-invasive LF parameters are desired. Magnetic resonance elastography (MRE) is as accurate at assessing LF as liver biopsy. Mac-2 binding protein glycosylation isomer (M2BPGi) was reported to be a reliable serum marker for predicting LF and measuring liver function after antiviral therapy. HCV infections are relatively common among dialysis patients；however, the kinetics of the abovementioned non-invasive LF parameters in dialysis patients are unknown. Herein, we described the cases of 5 HCV-infected dialysis patients that were treated with direct-acting antivirals and underwent liver MRE and M2BPGi monitoring before and after treatment. Case 1 involved a 48-year-old male with liver cirrhosis (LC), who was treated with elbasvir and grazoprevir. Case 2 involved a 53-year-old male, who was treated with elbasvir and grazoprevir. Case 3 involved a 60-year-old male, who was treated with glecaprevir/pibrentasvir. Case 4 involved a 79-year-old female, who was treated with daclatasvir and asunaprevir. Case 5 involved a 78-year-old female, who was treated with ombitasvir, paritaprevir, and ritonavir. All patients achieved sustained virological responses at 12 and 24 weeks. The mean liver MRE values of the LC (n＝1) and non-LC (n＝2) patients were 5.6, and 2.25 and 2.9 kPa, respectively, and did not change after treatment. On the other hand, the M2BPGi levels of the LC and non-LC groups decreased from 2.59 to 1.51 C.O.I. and from 1.88 to 1.31 C.O.I., respectively, after treatment. Liver MRE was effective and accurate at assessing liver fibrosis in dialysis patients. Also, the M2BPGi levels of dialysis patients decreased after direct-acting antiviral treatment, as has been reported for non-dialysis patients.

A hemodialysis catheter-related right atrial thrombus (RAT) is a rare complication with a poor prognosis. We describe a case of a hemodialysis catheter-induced RAT, which was successfully treated with open heart surgery. A 77-year-old female started undergoing hemodialysis for end-stage renal failure caused by autosomal dominant polycystic kidney disease. Due to frequent vascular access problems and the progression of dementia, a tunneled cuffed catheter with a self-centering split-tip (Centros FLO) was inserted into the right atrium via the left jugular vein. A part of the subcutaneous tunneled catheter became exposed, prompting the patientʼs hospitalization. She was diagnosed with a catheter infection. Thus, we decided to remove the catheter. Echocardiography and computed tomography scans demonstrated a thrombus at the catheter tip in the right atrium. The catheter and thrombus were removed by open heart surgery. The patientʼs postoperative course was uneventful. In conclusion, when extracting cuffed catheters with a split-tip, it is useful to check for a RAT through imaging examinations, such as echocardiography.