Peritoneal dialysis (PD) is a home-based renal replacement therapy with possible clinical merit for the cardiovascular system. However, it has been reported that more than half of PD patients present overhydration (OH), which inversely impacts the technical and life survival of patients. Inadequate salt and water intake play a central role in the pathology of OH. Moreover, some PD-specific pathological factors need to be considered such as the PD solution. Exposure to high glucose, accumulation of icodextrin metabolites, and hyponatric ultrafiltration due to the sodium-sieving effect of peritoneum can increase plasma osmolality, leading to development of chronic OH through preserving water in the body. This pathology concept may suggest therapeutic strategies to improve the quality of PD therapy in the future, such as novel icodextrin solution usage to avoid metabolite accumulation in blood and the development of low sodium solution to allow isonatric ultrafiltration.

A 51-year-old female with type Ⅱ diabetes mellitus and end-stage kidney disease undergoing hemodialysis presented with scattered, itchy skin lesions with umbilicated papules, sticked keratin, and a fixed crust, primarily located on the face, trunk, and tensor surfaces of the limbs, around 2017. Topical ointments had been ineffective. As acquired reactive perforating collagenosis (ARPC) was strongly suspected by a dermatologist, steroid ointment and antiallergic agents were prescribed. Additionally, minocycline (200 mg/day) was administered for ARPC. Severe pruritus and skin lesions were improved by these treatments. It is important to consider ARPC as a differential diagnosis of pruritus among patients on dialysis, and minocycline may be an effective treatment option.

A 31-year-old woman with systemic lupus erythematosus (SLE) complicated with lupus nephritis and antiphospholipid antibody syndrome (APS) was started on hemodialysis at 26 years old. Although anticoagulants for APS were started at the age of 19, they were discontinued due to complications of alveolar hemorrhage. After SLE and APS had resolved, she underwent ABO-incompatible living donor renal transplantation at the age of 31 years, with her mother as the donor. The risk of thrombosis is high for recipients of living donor renal transplantation with APS, and antithrombotic therapy is generally prescribed. In the present case, antithrombotic therapy was started 7 days before surgery, and the patient had no major complications, including thrombosis after surgery. Considering the risk of bleeding complications, antithrombotic therapy was discontinued on the 67th postoperative day. However, 150 days after the surgery, the peripheral blood flow was disrupted from the left upper extremity shunt, and antithrombotic therapy was resumed for thrombosis. There is no consensus regarding the risk stratification of thrombosis or timing of terminating anticoagulants in patients with APS, and so further studies are warranted.