In Japan, glycated albumin (GA) is used to evaluate glycemic control in diabetes dialysis patients based on the ‘Best Practice for Diabetic Patients on Hemodialysis 2012’ guidelines. A GA target value of less than 20.0％ is recommended in patients without a history of cardiovascular disease, whereas less than 24.0％ has been suggested in patients with a history of cardiovascular disease and in patients with hypoglycemic tendencies. Recently, several clinical studies regarding GA values and mortality of dialysis patients have been performed. Diabetes patients undergoing dialysis experience naturally improved glycemic control and normal-to-low HbA1c levels with a decline in residual kidney function after starting dialysis therapy, with or without antidiabetic agents. This phenomenon is called ‘burnt-out diabetes.’ It has been reported that burnt-out diabetes is associated with poor prognosis in diabetes dialysis patients (especially HbA1c＜5.0％). However, it is important to evaluate the true prevalence and prognosis of burnt-out diabetes in combination with GA.

The Okinawa Dialysis and Transplant Association (ODTA) holds an annual meeting. Its 40th meeting was held on March 5, 2023. The first ODTA meeting was held in 1983, which was 2 years after the settlement of the University of the Ryukyus. Okinawa is located in the southernmost part of Japan and consists of 47 inhabited small islands. We reviewed past programs to identify the trends of dialysis treatment in Okinawa. The total number of abstracts from the member hospitals and clinics was 1,635 consisting of 492 (30.1％) by physicians, 415 (25.4％) by technicians, and 728 (44.5％) by nursing staff. By reviewing the specially invited lectures, we identified topics that are still important for current practice such as kidney transplantation, continuous ambulatory peritoneal dialysis, computer problems, and patient-reported outcomes including depression, loneliness, insomnia, and itching. In collaboration with the Okinawa Dialysis Physicians Association, we discuss several important management problems such as natural disasters (earthquakes, tsunamis, typhoons, water, and electric shortage), infection (new strains of influenza, COVID-19), and shortage of medical staff. With the collaboration of all dialysis units, we have been surveying COVID-19 infections since the beginning of February 2020. We found that a total of 1,047 dialysis patients (22.1％ of the total) were infected by the end of August 2022 which was lower than that of the general population (32.7％). We also surveyed the use of hypoxia inducible factor prolyl hydroxylase (HIF-PH) inhibitors from June to August 2021. A total of 196 patients have received treatment with HIF-PH inhibitors since December 2019 in 35 out of 74 dialysis units. Their mean age (duration of dialysis) was 68.5 (7.8) years and 32.7％ had diabetes mellitus. Upon overviewing the ODTA40, we aim to articulate the historical changes in dialysis therapy and future themes for better QOL and survival of dialysis patients. We hope that our findings will empower healthcare staff.

A 66-year-old woman had been on peritoneal dialysis (PD) due to Alport syndrome for three years. She consulted the hospital with complaints of dialysis effluent turbidity and fever persisting from the previous day. She was admitted to the hospital with a diagnosis of PD-related peritonitis due to an increased number of neutrophil-predominant cells in the dialysis effluent. Intraperitoneal cefazolin and ceftazidime were started. On the third day, the number of cells in the effluent did not decrease and there was no improvement in effluent turbidity, so we switched to intraperitoneal meropenem on the fourth day. Bacterial culture of the effluent appeared negative at first, but Bacteroides ovatus and Eggerthella lenta were detected later by enrichment culture. Thereafter, the number of cells in the dialysis effluent began to decrease, but the patient relapsed with peritonitis on day 11. The PD catheter was removed on day 14 and the patient was transferred for hemodialysis. Some enteric bacteria that cause endogenous PD-associated peritonitis are resistant to CEZ＋CAZ, which is the first-line therapy. We report a case of peritonitis caused by a markedly rare pathogenic bacterium, along with a review of the literature.