Hemodialysis patients often have dietary restrictions set for salt, water, protein, potassium, and phosphorus, which loads a significant psychological burden on them. However, congestive heart failure and hyperkalemia are complications that require daily vigilance. Because dialysis patients do not excrete potassium in urine, it has been considered that potassium intake directly affects serum potassium levels, and a potassium‒restricted diet has typically been recommended. Recently, it was reported that potassium intake and serum potassium levels do not correlate even in dialysis patients. In malnourished dialysis patients (especially the elderly and those with various comorbidities), potassium restriction can further reduce protein intake, which may be associated with a reduced quality of life (QOL) and poor prognosis. Potassium restriction in hemodialysis patients should be implemented based on careful consideration of each individual patient’s circumstances and managed by a medical team that includes staff (nurses, registered dietitians) who favorably communicate with the patient on a daily basis.

Treatment of patients with renal anemia has traditionally centered on erythropoiesis‒stimulating agents (ESAs), but a patient subset shows ESA resistance due to chronic inflammation and impaired iron utilization. Hypoxia‒inducible factor prolyl hydroxylase (HIF‒PH) inhibitors have emerged as a novel option； they simultaneously promote endogenous EPO production and improve iron metabolism, although their long‒term efficacy and optimal use remain unclear. In this study, we followed patients with ESA‒resistant renal anemia treated with roxadustat (Rox), daprodustat (Dap), or enarodustat (Ena) for 100 weeks, comparing hemoglobin control, dosage, and safety. Machine‒learning analysis identified baseline iron metabolism, hematopoiesis, and copper metabolism as key factors influencing treatment responsiveness. Early assessment of these factors may facilitate the prediction of poor responders and help maximize treatment outcomes.

We report a case of cefepime (CFPM) encephalopathy developing after seven‒week administration of CFPM in a patient with kidney dysfunction, who subsequently recovered after hemodialysis (HD). The patient was initially treated with CFPM for pyogenic spondylitis. Fifty days after starting CFPM, he developed impaired consciousness, with a Japan Coma Scale (JCS) score of 10. After undergoing HD for 3 consecutive days, his consciousness level improved to a JCS score of 0, leading to the clinical diagnosis of CFPM encephalopathy. Blood concentrations of CFPM were 174 and 12 μg/mL before and after HD, respectively (recommended therapeutic concentration around 46 μg/mL). CFPM encephalopathy should be considered as a differential diagnosis in patients with impaired consciousness associated with kidney dysfunction, and HD is effective in treating those with CFPM encephalopathy due to its ability to efficiently remove CFPM.

With the increasing use of immune checkpoint inhibitors (ICIs) for patients with malignant tumors, reports of immune‒related adverse events (irAEs) are also rising. In particular, irAEs associated with combination therapy using ipilimumab and nivolumab are often severe, with neuromuscular disorders such as myasthenia gravis (MG), myositis, and myocarditis being characteristic manifestations. Myasthenia gravis associated with irAEs (irAE‒MG) can be fatal due to rapid‒onset respiratory muscle paralysis, yet optimal treatment strategies remain unestablished. We report the development of delayed‒onset irAE‒MG crisis in a patient during treatment with corticosteroids and abatacept for concurrent irAE‒myositis and myocarditis. The patient’s condition, which was refractory to the existing therapy, improved following the addition of plasma exchange. Herein, we discuss the significance of plasma exchange for patients with severe irAE‒MG, particularly when complicated by myocarditis, based on our case and a review of the literature.

We describe the successful creation of an atypical radiocephalic arteriovenous fistula in a patient with inadequate forearm cephalic veins. Preoperative vascular mapping revealed the bilateral absence of suitable cephalic trunks from the mid‒forearm to antecubital fossa, indicating a high risk for early fistula failure. The radial artery demonstrated superior flow compared with ulnar artery, while the basilic vein maintained patency throughout the forearm. The only viable anastomosis site was identified at the distal cephalic vein connecting to the dorsal venous arch. A 4‒mm side‒to‒side anastomosis was created between the radial artery and distal cephalic vein to redirect flow through the dorsal venous network into the basilic vein. Postoperatively, although antegrade cephalic outflow stopped immediately, the basilic vein adequately developed, establishing functional vascular access. The fistula remained viable for over five years with periodic percutaneous transluminal angioplasty interventions. This case illustrates that atypical arteriovenous fistulas utilizing basilic outflow remain viable options when conventional cephalic pathways are unavailable, provided patent dorsal venous communications exist.