Non-occlusive mesenteric ischemia (NOMI) occurs more frequently in dialysis patients than in non-dialysis patients and is associated with an extremely poor prognosis. In many cases, however, direct triggers for NOMI remain unclear. This study was aimed to clarify the clinical characteristics of hemodialysis patients with NOMI and examine their relationship with the onset of NOMI. Nineteen patients with NOMI were divided into group A (n＝9) who had obvious triggers (cardiac surgery, cardiogenic and hemorrhagic shock) and group B (n＝10) with undetermined causes. Although APACHEⅡ scores tended to be lower in group B than in group A, there was a stronger tendency to have a history of arteriosclerotic diseases and the mortality rate was similar (group A：77.8％, group B：60％, p＝0.63). The dose of erythropoiesis-stimulating agents (ESAs) was higher in group B (7,000 vs. 3,000 U/week, respectively, p＝0.015) and the erythropoiesis resistance index (ERI) tended to be greater (12.9 vs. 4.3 U/kg/g/dL/week, respectively, p＝0.058). Group B showed weight loss and elevated hematocrit at the onset of NOMI. In conclusion, the mortality rate is high even in patients who have NOMI but no obvious triggers, such as cardiovascular surgery and cardiogenic/hemorrhagic shock. Underlying arteriosclerotic tendency, EPO doses/responsiveness, decreased circulating blood volume, and decreased mesenteric blood flow due to hemoconcentration and impaired blood fluidity may be involved in the development of NOMI.

［Objective］This study aimed to investigate the efficacy and safety of switching from etelcalcetide to upacicalcet for secondary hyperparathyroidism in maintenance hemodialysis patients.［Methods］We retrospectively evaluated 90 hemodialysis patients (65 males, 25 females) undergoing treatment for secondary hyperparathyroidism who were switched from etelcalcetide to upacicalcet. The patients were divided into 4 groups according to the etelcalcetide dose：low-dose group (2.5 mg), medium-dose group (5 mg), high-dose group (7.5-10 mg), and very-high-dose group (15 mg). When switching, upacicalcet was started at 25 μg in all patients, and then the dose was adjusted to maintain whole-parathyroid hormone (PTH) levels within 35-150 pg/mL. Whole-PTH, phosphate, and calcium (Ca) levels were measured every 4 weeks.［Results］After switching, in high-dose and very-high-dose groups, Whole-PTH and corrected Ca levels increased, but subsequently decreased to pre-switch levels with increasing doses of upacicalcet. The target achievement rates of Whole-PTH levels after 48 weeks were：100, 88.7, 86.7, and 71.4％ in low-, medium-, high-, and very-high-dose groups, respectively, which were higher than before the switch. No adverse events such as hypocalcemia were observed.［Conclusion］Switching to upacicalcet in maintenance hemodialysis patients treated with etelcalcetide for secondary hyperparathyroidism involves no particular safety or efficacy concerns. However, careful attention should be paid to transient increases in Whole-PTH and corrected Ca levels when switching from more than 7.5 mg of etelcalcetide to 25 μg of upacicalcet.

For hemodialysis patients to continue dialysis therapy, maintaining attention and executive functions is crucial. Existing evidence revealed that hemodialysis patients have a high prevalence of cognitive function decline. However, attention span and executive functions, which are part of cognitive functioning, have not been sufficiently verified. Therefore, this study aimed to assess the actual state of attention and executive cognitive functions in hemodialysis patients. The study included 32 hemodialysis patients and 31 age-matched community residents without chronic kidney disease. Attention sustenance and executive functions were evaluated using the Trail Making Test (TMT-B). Hemodialysis patients required more time to complete TMT-B than age-matched community residents, suggesting that hemodialysis patients have higher risks of decreases in attention regulation and executive cognitive function. Moreover, attention and executive functions were negatively correlated with grip strength and skeletal muscle mass. Additional longitudinal studies will be planned to further examine these observational results.

When performing transcatheter aortic valve implantation (TAVI) in hemodialysis patients, a trans-femoral approach is often infeasible due to peripheral arterial disease. However, there are no sufficient data on the safety of a trans-subclavian approach ipsilateral to the dialysis shunt arm. In this report, we describe four cases of TAVI via the subclavian artery ipsilateral to the shunt arm. The patients were between 70 and 79 years old and had a dialysis shunt in the left forearm. All of them were considered to be at high risk for surgical aortic valve replacement (STS scores：6.292-12.624)；therefore, TAVI was performed after multidisciplinary heart team discussion. A left subclavian artery approach was selected because of iliac artery stenosis or severe calcification in the common femoral artery. The preprocedural aortic valve pressure gradient ranged from 30.2 to 44.2 mmHg；postprocedure, it decreased to 3.0-5.8 mmHg. After TAVI, all patients were able to undergo hemodialysis without shunt failure or subclavian artery stenosis. In these cases we have encountered, the postoperative hemodialysis course was uneventful, suggesting that TAVI via a trans-subclavian approach ipsilateral to the shunt arm can be performed safely.

Peritoneal dialysis-associated peritonitis is an important complication among peritoneal dialysis patients. Cephalosporins, including cefepime (CFPM), are the initial treatment choice for such cases. We present the case of an 86-year-old woman undergoing peritoneal dialysis treatment for renal failure due to nephrosclerosis. Five months after the induction of peritoneal dialysis, the patient developed peritonitis, and we started treatment with intraperitoneal cefazolin (CEZ) 1 g and CFPM 1 g/day. Peritonitis improved, but consciousness disorder developed five days post-hospitalization. Electroencephalography showed triphasic waves, while brain MRI showed no significant changes；thus, antibiotic-associated encephalopathy due to cephalosporins was suspected. CEZ and CFPM were discontinued, and meropenem was started. The patientʼs consciousness improved and antimicrobial therapy was stopped on the 14th day post-admission. The patient developed antibiotic-associated encephalopathy despite intraperitoneal administration of an adjusted CFPM dose. Caution should be exercised when treating peritoneal dialysis patients with cephalosporin antimicrobials, even when administered intraperitoneally, to avoid antibiotic-associated encephalopathy development.