In dialysis patients, coronary artery disease, coronary artery calcification, and the factors associated with them were compared between two groups of patients；i.e., diabetic nephropathy patients vs. non-diabetic nephropathy patients. This study involved 283 maintenance dialysis patients, including 154 in the diabetic nephropathy group and 129 in the non-diabetic nephropathy group. The presence or absence of coronary artery disease was determined based on each patientʼs history of coronary artery revascularization, while the extent of coronary artery calcification was assessed by examining coronary artery computed tomography images using the Agatston coronary artery calcium score. Coronary artery disease was significantly more common in the diabetic nephropathy group than in the non-diabetic nephropathy group (p＜0.05). However, the extent of coronary artery calcification did not differ significantly between the groups (p＝0.396). Only duration of dialysis (r＝0.344, p＜0.05) and the β₂―microglobulin (β₂MG) level (r＝0.262, p＜0.05) were found to be correlated with the coronary artery calcium score. These results revealed that in dialysis patients the coronary artery calcium score is not related to the differences in coronary artery lesions between diabetic nephropathy and non-diabetic nephropathy patients, whereas it is correlated with duration of dialysis.

Lymphatic fistulas are a rare complication after superficialization of the brachial artery, and there are no established treatment guidelines. We report a case of refractory lymphatic fistulas after superficialization of the brachial artery, which was successfully treated with a combination of nutritional therapy and invasive procedures. A 72-year-old male with short bowel syndrome developed lymphatic fistulas after bilateral superficialization of the brachial artery. Invasive treatment was employed for the left lymphatic fistula, which healed within 174 days. On the other hand, a combination of invasive treatment and nutritional therapy was used for the right lymphatic fistula, which healed within 69 days. Compared with invasive treatment alone, the addition of nutritional therapy shortened the recovery time of a refractory lymphatic fistula in a hypotrophic patient. Appropriate nutritional management may lead to early improvement of refractory lymphatic fistulas after superficialization of the brachial artery in hypotrophic patients.

A survey was conducted among dialysis physicians in Tochigi Prefecture regarding the discontinuation or withholding of dialysis and kidney palliative care. Thirty-five questionnaires were sent to 21 facilities, and 20 (57.1％) valid responses were received. Eighteen respondents (90％) said they had experience of conservative kidney management (CKM). They also had experience of withdrawing patients from dialysis. Fourteen (70％) had used opioids to relieve symptoms in patients with end-stage renal failure. Seventeen (85％) agreed that palliative care should be provided to patients with end-stage renal failure. Many dialysis physicians had experience of CKM and withdrawing patients from dialysis, and were willing to provide palliative care.