In Japan, the Classification (or Staging) of Diabetic Nephropathy revised in 2014 has been widely used. Since 2022, the Joint Committee on Diabetic Nephropathy has discussed the need to revisit the staging due to the diverse kidney phenotype in individuals with diabetes against the background of aging of the population, an increase in obese individuals, and the development of new therapeutic agents for diabetes and hypertension. As of now, no new evidence has been presented that suggest the necessity of changing the basic framework of the 2014 staging, which was based on the levels of albuminuria and estimated glomerular filtration rate. Therefore, the Committee has decided not to alter the fundamental structure of the 2014 staging. However, with a focus on maintaining consistency with the CKD classification by the Japanese Society for Nephrology and international notation, the former stages have been renamed as follows："normal albuminuria (stage 1)", "microalbuminuria (stage 2)", "macroalbuminuria (stage 3)", "severely decreased GFR/end-stage kidney disease (stage 4)", and "kidney replacement therapy (stage 5)".

[Objective] To investigate factors hindering the spread of assisted peritoneal dialysis (PD) to support elderly patients in Japan, a survey of PD acceptance at home nursing stations was administered. [Method] A questionnaire survey was conducted involving 616 home-visit nursing stations in Aichi Prefecture, 368 of which were registered with the Aichi Medical Association or Aichi Council of Home-Visit Nursing Stations. [Results] A total of 132 facilities were surveyed, for a collection rate of 35％. The breakdown was as follows：37 home nursing stations were accepting PD patients, 59 were considering accepting PD patients, and 20 were not considering accepting PD patients. A total of 20％ of the facilities were always involved in PD patient visits. Other facilities had only a few opportunities to see PD patients per year. The most common conditions for acceptance by visiting nurses were："medication management" and "emotional support," followed by "PD-bag exchange" and "exit site care". The most common considerations for acceptance were："preparation of APD cycler" and "monitoring the operation of APD equipment," such as preparation of APD equipment. [Conclusion] In order for home health care nurses, who are key personnel in ASSISTED PD, to be able to accept PD patients without anxiety, collaboration and multidisciplinary cooperation, such as joint visits and sharing of care methods with medical staff at PD treatment facilities, are required.

There are still many unclear points regarding cancers occurring in dialysis patients. A questionnaire survey was conducted involving patients receiving dialysis treatment between 2015 and 2019 at 56 dialysis facilities in Okinawa Prefecture regarding any cancer history. During those five years, 408 cancers were diagnosed in 263 males and 145 females. In males, colorectal, kidney, and lung cancers were common, in that order. In females, breast, kidney, and colorectal cancers were common, also in that order. Lung cancer is often diagnosed early with the induction of dialysis and is common in the elderly, and the smoking rate among patients is also high. The prevalence of kidney cancer was high in both males and females, with a mean patient age of 65.6±11.1 years and the median time from the initiation of dialysis to onset of cancer being 12.4±8.9 years. In an analysis that included cancers before the start of dialysis, most cancers were diagnosed within five years after the induction of dialysis, followed by those within five years before dialysis. In addition, most cancers occurred within 1 year before or after the induction of dialysis. In the future, it will be necessary to clarify the characteristics of cancer in dialysis patients throughout Japan and adopt appropriate measures.

To elucidate the effects of ultrafiltration of water in hemodialysis (HD) on total body water (TBW) and body fat mass (FM), both of which were measured by segmental multi-frequency bioelectrical impedance analysis (sMF-BIA), we evaluated the relationship between the ultrafiltered water volume and TBW as well as FM before (pre-) and after (post-) HD in 67 HD patients. The mean ultrafiltration volume and change in TBW at pre- and post-HD were in good agreement for both male and female HD patients；however, the difference between the two tended to become greater with an increasing ultrafiltration volume. When the standard physiological hydration ratio of the fat-free mass (TBW/FFM), i.e., 0.73, was applied to that at post-HD, FM at pre-HD was theoretically estimated to be lower than that at post-HD, by about 37％ of the ultrafiltration volume. Both the estimated and measured values of FM at pre-HD were in good agreement for both males and females. In conclusion, a large ultrafiltration volume might affect TBW measured by sMF-BIA, suggesting that the measured FM may be affected by an increased TBW/FFM due to pre-HD overhydration.

We measured Abbottʼs S1-RBD IgG antibody titers before and after the third dose of Modernaʼs COVID-19 vaccine in hemodialysis (HD) patients, and examined factors affecting antibody titers. We used Pfizerʼs BNT162b2 (Pfizer) until the second vaccination, and Modernaʼs mRNA-1273 (Moderna) for the third vaccination 6 months after the second vaccination. Antibody titers increased markedly from a median of 275 (149-571) AU/mL before vaccination to 29,737 (14,984-46,185) AU/mL (108.1-fold) one month after vaccination. Multiple regression analysis showed that post-immunization antibody titers were lower in steroid-naive patients, and were also lower in patients with a lower BMI with the exception of those with a BMI of 30 or higher. The results suggest that hemodialysis patients who show emaciation or take steroids need to take more care regarding infection protection after vaccination.

A 41-year-old man developed peritoneal dialysis-associated peritonitis due to Streptococcus salivarius approximately one year after the introduction of peritoneal dialysis. Blood-borne infection due to severe periodontitis was suggested as the cause. We consider that oral examination and care are important to prevent the development of peritonitis.

The patient was a 68-year-old woman. She was diagnosed with hypertension at around the age of 40. At about age 50, she showed a decline in her renal function, with the level of serum creatinine at 1.2 mg/dL. Her renal function gradually worsened, and she was referred to our hospital at age 66 for peritoneal dialysis as renal replacement therapy. She was diagnosed with bilateral neovascular glaucoma at age 67 and underwent trabeculectomy of the left eye at age 68. Due to visual impairment, management of her peritoneal dialysis became difficult and blood cleaning efficiency decreased, leading to hospitalization for hybrid dialysis. Low-efficiency hemodialysis using glycerol was started to prevent intraocular pressure elevation. The patient presented with pain in her right eye two hours later, and alcohol blocks were performed in the ophthalmology department to control her intraocular pressure. The right eye pain improved and hemodialysis was performed again, but the right eye pain recurred the same as before. We determined that the patient could not continue hemodialysis. During peritoneal dialysis, no pain occurred in her right eye. Glaucoma attacks became apparent during hemodialysis, suggesting that intraocular pressure elevations during hemodialysis can be caused by the same mechanism as in imbalance syndrome. We present our experience whereby peritoneal dialysis could be safely performed for a glaucoma patient with poorly controlled intraocular pressure as renal replacement therapy.