[Objectives] The study aimed to identify differences in the impact of dialysis methods (PD and HD) on ADL, the vital prognosis, and cognitive ability of the elderly aged 75 or over. [Method] Patients aged 75 or over, who went through sufficient SDM and were newly introduced to PD or HD, were included in either the PD or HD group and measured with KPS and the Barthel Index every three months and Revised Hasegawa Dementia Scale (HDS-R) every six months for a period of two years. [Results] During the two years starting on May 1, 2018, 18 patients were included in the PD group, and 40 patients were included in the HD group. The average age of the PD group (83.2±4.2) was significantly higher (p＝0.007) than that of the HD group (80.0±3.6). The amount of change of the Barthel Index and KPS from the baseline revealed significant improvement in the HD group, demonstrated by significantly higher scores compared with those in the PD group. Neither group showed any significant change in HDS-R scores during the observation. No significant differences between the two groups were observed in terms of the duration until death, ADL degradation up to KPS 30 or lower, and the loss of cognitive ability to the extent that continuation in the study was difficult. [Conclusion] ADL of the HD group showed significant improvement after the start of dialysis. The average age of the PD group was significantly higher than that of the HD group, but there were no significant differences in cognitive decline or the observation period.

Neutralizing antibodies are expected to reduce the severity of novel coronavirus disease 2019 (COVID-19) in hemodialysis patients. Among hemodialysis patients with COVID-19 who were admitted to our hospital from August to September 2021, we treated 8 patients who met the criteria for the use of casirivimab/imdevimab (REGEN-COV). The mean age of the patients was 72.8 years, five were male, four had received two doses of the vaccine, and three had received one dose. REGEN-COV was administered on average 3.8 days after the onset of COVID-19. Four patients showed pneumonia before REGEN-COV administration. One patient with 7 risk factors for severe disease other than chronic kidney disease had no evidence of pneumonia before receiving REGEN-COV administration, but developed new signs of oxygen demand and pneumonia after REGEN-COV, and died on day 13. Most of the patients followed a favorable course after REGEN-COV administration, but there were some cases of severe disease. In hemodialysis patients, REGEN-COV may not prevent severe disease when the number of risk factors for severe disease is high. In addition, there are reports that the efficacy of REGEN-COV is weakened with omicron strains, so the number of risk factors for severe disease and virus strains should be taken into consideration when REGEN-COV is used.

A 63-year-old woman visited our hospital for the treatment of liver cirrhosis and chronic renal failure. Three years ago, she developed anemia and thrombocytopenia. Furthermore, she was diagnosed with hypersplenism associated with liver cirrhosis by a hematologist. Two years ago, she was started on maintenance hemodialysis and given an erythropoiesis-stimulating agent for the treatment of anemia. However, its effect was insufficient. Moreover, frequent red blood cell transfusions failed to resolve her anemia. Hence, she was admitted to our hospital, where she underwent partial splenic embolization (PSE). Two months after the procedure, she developed a splenic abscess, which was relieved by drainage and antibiotic administration. Further blood transfusion was not required. There are few reports of PSE in patients with hypersplenism requiring maintenance hemodialysis. We report a case that suggests the usefulness of PSE treatment.

The patient was a 67-year-old man who had been receiving treatment at our hospital for chronic kidney disease since 20XX-3. Because his general malaise, diarrhea, and anemia progressed from March 20XX, the patient was admitted to the hospital and underwent detailed examinations, but the cause could not be identified. In the same year, the patient began emergency dialysis due to hyperkalemia and metabolic acidosis. Although frequent blood transfusions and treatment with increased doses of erythropoiesis-stimulating agent preparations were performed, the patientʼs anemia showed minimal improvement, and his intractable diarrhea and high inflammatory response continued. A bone marrow biopsy was performed, and he was diagnosed with peripheral T-cell lymphoma. It was decided that the T-cell lymphoma would be followed by careful observation, and treatment for his anemia was continued. Collagenous colitis (CC) was diagnosed by lower gastrointestinal endoscopy performed for the purpose of detailed examination to identify the cause of the diarrhea. When the suspected drug, i.e., proton pump inhibitor (PPI) was discontinued, his symptoms improved. In this case, the chronic inflammation caused by CC was considered to be the main cause of his anemia. In hemodialysis patients, it is necessary to reduce the dose of H2 blockers from the viewpoint of renal dysfunction, and so the frequency of PPI use increases. Therefore, it is essential to recognize CC as a differential diagnosis for diarrhea in such patients.