The aim of this study was to determine the association between hemodialysis (HD) patients’ physical activity (PA) and transportation to HD facilities. Four hundred and one patients from 8 centers were divided into 3 groups based on the method of transportation to HD facilities： walking (including public transportation) group, private car group, and shuttle bus group. Physical activity was quantified using the International Physical Activity Questionnaire (IPAQ), short form Japanese version. PA decline was defined as falling into the category of low physical activity (Low). We analyzed the association between PA decline and transportation to HD facilities in all subjects and subgroups based on age. The private car and shuttle bus groups had a higher risk of PA decline than the walking group, even after adjusting for covariates including physical function (private car： odds ratio [OR], 1.89 [1.00-3.55], p＝0.04； shuttle bus： OR, 2.67 [1.30-5.46], p＝0.01). In subgroup analyses, the private car group was independently associated with the risk of PA decline among middle age adults (＜65 years) (p＝0.04), and the shuttle bus group was independently associated with the risk of PA decline among the early elderly (65-74 years) (p＜0.001), compared with the walking group. On the other hand, there was no significant correlation between PA decline and transportation to HD facilities in the late elderly (≥75 years). Transportation to HD facilities was identified as a factor involved in PA decline in older to early elderly HD patients, independent of the physical function.

Patient education is important in peritoneal dialysis (PD) due to its home-based nature. Such education requires the acquisition of specialized knowledge. In order to maintain an appropriate level of patient education, it is considered important to establish an educational method for young ward staff. We used the "PD Instruction Evaluation Chart" to help staff members develop fundamental PD knowledge and techniques. Additionally, the “Reflection Sheet” helped them evaluate the patient instructions they gave in actual practice. While the “PD Instruction Evaluation Chart” alone tends to confirm knowledge without considering individual patient needs, its combined use with the “Reflection Sheet” enables staff to appreciate the importance of personalized instruction. Teaching with this dual approach using both the “PD Instruction Evaluation Chart” and “Reflection Sheet” is efficient and effective for educating young staff during the introductory phase of PD. In the future, we would like to evaluate how this educational method contributes to improving the quality of patient care.

The patient was a 58-year-old female who had been a kidney donor in her thirties. She had a history of adhesive intestinal obstruction due to uterine disease and received ileostomy and colostomy. She was frequently dehydrated and had acute kidney failure due to a high-output stoma. Her peripheral veins of the extremities were exhausted by repeated canulation for treatment of dehydration. She frequently developed catheter-related infections with the use of both tunneled and non-tunneled catheters. Her renal function gradually deteriorated into end-stage kidney disease. Single-needle hemodialysis was conducted by puncturing the internal jugular vein (IJV) with echocardiographic guidance, because it was difficult for her to undergo arteriovenous fistula creation and grafting. After confirming the safety of this technique, we created a superficial brachial artery, and IJV was used to return blood in every dialysis session. A small hematoma developed at the IJV puncture site only once, and there were no serious complications such as infections, bleeding, or large hematomas for more than two years. Puncturing IJV with echocardiographic guidance may be a useful and safe method of vascular access, especially in cases involving access failure of the extremities. It is also useful to avoid CVC-related complications.

The occurrence of peritoneal dialysis-related peritonitis (PD-related peritonitis) caused by non-tuberculous mycobacteria (NTM) is rare； therefore, case reports of rapidly growing mycobacteria (RGM) are limited. Here, we present a case of PD-related peritonitis caused by Mycobacterium abscessus (M. abscessus) for which treatment was successful after considering clarithromycin (CAM) resistance on selecting antimicrobial agents. A 50-year-old male presented with fever and abdominal pain, leading to a diagnosis of PD-related peritonitis based on clinical and laboratory findings. Initial antibiotic therapy led to limited improvement, and on the 3rd day, growth of NTM colonies was observed, prompting a diagnosis of peritonitis caused by RGM. After considering CAM resistance, combination therapy with imipenem (IPM), amikacin (AMK), and ciprofloxacin (CPFX) was initiated, resulting in an improved inflammatory response. It is noteworthy that CAM resistance is frequently reported in RGM, with M. abscessus acquiring resistance at a frequency of 79.3 to 93.8％. The mechanisms of resistance are known to involve the erm and rrl genes, and there are differences in the rate of resistance acquisition among subspecies of M. abscessus. Due to the high frequency of RGM among NTM, it is advisable to consider RGM on selecting antimicrobial agents when NTM infection is suspected.

We report a female patient in her 70s who developed end-stage renal disease (ESRD) and was treated with assisted peritoneal dialysis (assisted PD). The patient developed schizophrenia in her 50s. She subsequently developed ESRD due to hypertensive nephropathy and consented to renal replacement therapy (RRT) in her 70s. However, the severe positive symptoms of schizophrenia made it difficult for her to visit a hemodialysis clinic and perform PD independently. Therefore, the patient and her husband selected assisted PD with his support. The patient was admitted to our hospital for the initiation of PD due to uremic symptoms. We instructed her husband in PD techniques and coordinated home visits by a nephrologist and nurses. Since discharge from the hospital, the patient has continued assisted PD with home visits by a nephrologist and outpatient visits at our hospital every three months. There are few reports on appropriate RRT for patients with severe psychiatric disorders, but assisted PD, as in this case, may be beneficial. On implementing this approach, it is important to consult psychiatrists, coordinate social resources, and obtain the understanding and cooperation of family members.

The patient was a 58-year-old man who had been receiving maintenance hemodialysis therapy since he was 37 years old. Computed tomography (CT) for screening showed a renal tumor of 41 mm in diameter of the right kidney. He was referred to our department in August X. However, he suddenly developed cardiac tamponade and his planned visit to our department was postponed. After treatment for cardiac tamponade, he visited our department in September X. The kidney tumor had developed to 90 mm in diameter based on MRI in October X. Laparoscopic nephrectomy was performed in November X. We found that the tumor had spread to the liver. The pathology of the tumor was sarcomatoid renal cell carcinoma with spindle cells. Three months after the surgery, CT showed local recurrence. Pazopanib at 800 mg, a molecular-targeted drug which is effective against sarcomatoid tumors, was started. Lesion shrinkage was temporarily observed. However, seven months after the surgery, the lesion progressed. As second-line therapy, Avelumab at 540 mg plus Axitinib at 10 mg, combination treatment of a PD-L1 antibody and molecular-targeted drug, was started. Regardless of this, the lesion rapidly progressed, the general condition of the patient worsened, and he died 9 months after the surgery. Generally, renal cell carcinoma in patients on hemodialysis develops very slowly, but the disease may progress rapidly in some cases, as it did in the present case. When we identify a tumor, it is desirable to treat it without missing the optimal timing for treatment.