Pruritus is a severe complication frequently encountered in hemodialysis patients. It is often resistant to treatment due to the involvement of multiple factors in its development. Thus, it is imperative to actively administer cause-specific and comprehensive therapies to alleviate itching. However, the true extent of hemodialysis-associated pruritus remains unknown in several aspects, primarily due to the presence of ʻhiddenʼ patients. Herein, we aimed to investigate the status of hemodialysis-associated pruritus including its presence or absence, severity of itching, and its impact on the quality of life (QOL). We enrolled 485 hemodialysis patients who were recruited via the Internet. We found that 378 patients experienced itching, with over 20％ of them having encountered moderate or severe itching. A significant proportion of patients with moderate or severe itching experienced impairment in their QOL. Notably, 26.9％ of these patients remained untreated. Furthermore, ʻhiddenʼ patients with pruritus represented 21.7％ of the patient cohort that experienced itching. Hemodialysis-associated pruritus continues to affect a substantial number of patients；therefore, there is a pressing need for healthcare professionals to administer appropriate treatments.

[Objectives] This study aimed to evaluate the body iron composition of hemodialysis (HD) patients and the relationship between body iron status and clinical outcomes. [Subjects] The subjects were 568 patients (395 males and 173 females) who were receiving maintenance HD. [Methods] We retrospectively collected the data of HD patients for three years from April 2018. We calculated total body iron (TBI), iron stores, and red cell iron of HD patients using the initial data. Body iron results were expressed per body surface area. The primary endpoint was the dropout rate from outpatient maintenance HD (oHD) due to death or admission for more than one month. We performed log-rank test and Cox proportional hazard ratio (HR). Firstly, we divided the male and female patients into two groups based on median TBI. Secondly, we divided patients into four groups based on median iron stores and red cell iron. [Results] Low-TBI female patients had a higher oHD dropout rate (Log-rank p＝0.038, HR 2.119；95％ CI 0.984-4.563). Furthermore, high iron stores and low red cell iron female patients had a higher oHD dropout rate (Log-rank p＝0.021, HR 4.853；95％ CI 1.371-17.174). [Conclusions] Among female HD patients, those with low TBI or functional iron deficiencies, characterized by higher iron stores levels and lower red cell iron levels, were significantly less able to maintain oHD.

Abdominal computed tomography revealed an appendiceal tumor suspected to be a low-grade appendiceal mucinous neoplasm (LAMN) in a 79-year-old patient who underwent both peritoneal dialysis and hemodialysis. LAMN is a relatively rare disease that is not always malignant. Operative appendectomy is performed to prevent the development of pseudomyxoma peritonei. To prepare the patient for an early resumption of peritoneal dialysis, we performed laparoscopic appendectomy. Peritoneal dialysis was resumed without deterioration of peritoneal function.

Metformin is widely used as a treatment for type 2 diabetes. Although it is extremely rare, metformin-associated lactic acidosis (MALA) is a serious side effect. MALA requires prompt treatment due to its high fatality rate. Herein, we report a case of MALA in a 59-year-old woman with normal renal function that developed after Campylobacter jejuni enteritis and was successfully treated with prolonged hemodialysis. In general, hemodialysis is recommended over continuous hemodiafiltration because of its higher clearance if the patientʼs blood pressure can be maintained. On the other hand, there is a concern that prolonged hemodialysis may result in the removal of vitamins and other necessary components of the body. Therefore, we supplemented thiamine as needed and used an antibiotic that is not easily removed by hemodialysis. The patient had a history of epileptic seizure due to failure to take antiepileptic drugs. For this reason, she was committed to strict adherence to her medications and continued to take them even on days when she felt sick. When we start metformin prescriptions, it is essential to provide appropriate medication guidance to prevent serious complications.